Registration Form for the July 11th ACT Test Prep Course
Fill out the form carefully for registration
Parent Name
*
First Name
Last Name
Parent Phone
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Area Code
Phone Number
Parent Email
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Email
Address
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Street Address
Street Address Line 2
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Student Name
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Student E-mail
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School
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Grade Level
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7th Grade
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Current Composite Score
*
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Goal Score
*
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Location
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Online
South Huntsville
Course Type
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Standard Course
Crash Course
Course Day/Time
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Mon/Wed 3:30-6pm (Full)
Mon/Wed 6-8:30pm (Full)
Tues/Thurs 3:30-6pm
Tues/Thurs 6-8:30pm
Sat/Sun 1:30-5:15pm
Is the student taking the science test?
*
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Yes
No
Not Sure
The science test is now optional.
Diagnostic Test Date
*
Please Select
June 14th at 1:30pm
June 20th at 1:30pm
Not Sure
Will Need to Reschedule
Earliest possible is best
Final Mock Test Date
*
Please Select
July 3rd at 1:30pm
July 5th at 1:30pm
Not Sure
Will Need to Reschedule
Latest possible is best
Emergency Contact
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First Name
Last Name
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Additional Comments
Class Payment
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STANDARD Course - July 11th ACT
3-Point Score Increase Guarantee
$899.00
$
899.00
CRASH Course - July 11th ACT
$449.00
$
449.00
Payment Methods
Debit or Credit Card
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make your payment.
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