COE ACT Prep Course Application

Center of Excellence ACT Prep Course Application
Thank you for your interest in the Center of Excellence ACT Prep Course. This program is designed to help high school students strengthen ACT test-taking skills, build confidence, and improve college readiness.

Space is limited. Early application is encouraged.
Student Information
Student name:

First NameLast Name
High school:
Grade level:
Student email:
example@example.com
Student phone number:
Please enter a valid phone number.Format: (000) 000-0000.
Date of birth:

MonthDayYear
Date
Student home address:

Street Address

Street Address Line 2

CityState

Zip Code
Parent/Guardian Information
Parent/guardian name:

First NameLast Name
Relationship to student:
Parent/guardian email:
example@example.com
Parent/guardian phone number:
Please enter a valid phone number.Format: (000) 000-0000.
ACT Information
Have you taken the ACT before?
Most recent ACT composite score:
English:
Math:
Reading:
Science:
Target ACT score:
Planned ACT test date:

MonthDayYear
Date
Student Interest
Why are you interested in participating in the COE ACT Prep Course?
What areas of the ACT would you most like assistance with? (check all that apply)
Commitment
By submitting this application, the student agrees to actively participate in scheduled ACT preparation sessions, complete assigned practice activities, and demonstrate a commitment to improving academic and test-taking skills.
Student signature:
Parent/guardian signature:
Date submitted:

MonthDayYear
Date
Should be Empty:

Center of Excellence ACT Prep Course Application