The H3O Group Inc. UWORLD Registration Form

REGISTRATION FORM
Registration Type

ACT Individual RegistrationSAT Individual RegistrationACT Boot CampSAT Boot Camp
Student Information or Boot Camp Point of Contact
First and Last Name:
Student Date of Birth:

MonthDayYear
Date
Age:
Gender:
Email Address:
example@example.com
School(s) Desired To Attend
Required Acceptance ACT/SAT Score:
City:
State:
Educational Information
High School:
Current Grade:
Current GPA:
Projected High School Graduation Year:

MonthDayYear
Date
Attending Title I School:

YesNo
Have You Taken The ACT/SAT Before

YesNo
If yes, which test:

ACTSAT
Month
Year
Total Score:
How did you hear about the test prep program?

ParentFriendMentorWeb searchYouth programOther
Parent/Mentor Information
Name:
Date:

MonthDayYear
Date
Should be Empty:

REGISTRATION FORM