ACT Success Academy Registration
Please fill in the form below.
Student's Name
*
First Name
Last Name
Parent's Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Parent's E-mail
*
Student Email
*
example@example.com
Virtual Courses 2020
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February 14, 2022 - March 30, 2022 (Mondays and Wednesdays. Prepares students for April 5th test)
July 6, 2022 - August 10, 2022 (Mondays and Wednesdays. Prepares students for Sept.10th test)
Private Tutoring
Current school, grade, and age.
*
Have they taken the ACT before? If so, what were their scores? (Composite, English, Math, Reading, Science)
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Favorite and least favorite subject in school? Hobbies? Interests?
How did you hear about ACT Academy
*
NOTES (Anything else I should know?)
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