ACT Prep Request Form

ACT PREP Request Form

"Increasing Education...Increasing Success"
Name*

First NameLast Name
County of Residency*
School Name*
Grade Level*
Phone Number*
Please enter a valid phone number.
Alternate Phone Number
Please enter a valid phone number.
Email (Enter email twice to confirm.)*

Confirmation Emailexample@example.com
Are you a participant in the DEOC program?*
Registering for Sessions

Spots are chosen on a first come first serve basis. If one sessions fills up, you will be automatically added to the next session of that subject. Confirmation emails will be sent to confirm your spot.
Signature*

Clear
Today's Date*

MonthDayYear
Date
Select the ACT Prep date(s) and time(s) you would like to attend.

January 31, 2026 (8:00a.m.-12:00p.m.) - Math & ScienceFebruary 7, 2026 (8:00a.m.-12:00p.m.) - English & Reading
Should be Empty:

ACT PREP Request Form