ACT Prep Registration

STUDENT INFORMATION
Name *
Name
Home Phone *
Home Phone
Mobile Phone
Mobile Phone
Gender
PARENT / GUARDIAN INFORMATION
Parent/Guardian Name
Parent/Guardian Name
Parent/Guardian Mobile Phone
Parent/Guardian Mobile Phone
Parent/Guardian Work Phone
Parent/Guardian Work Phone
ACT NOW BACKGROUND INFORMATION
Have you participated in this program before?
Have you taken the ACT before?
Example: English _____ Math: _____ Reading:_____ Science: _____ Writing: _____
ADDITIONAL INFO
Enrolled in a federal free or reduced-price lunch program at school?
Reside in a foster home, are a ward of the state, or homeless?
Family received low-income public assistance or lives in federally subsidized public housing?