Registration Form

 

STUDENT NAME_____________________________________________________________

 

PARENT NAME _____________________________________________________________

 

ADDRESS_________________________________________________________

 

 

CITY______________________________      ZIP__________________________

 

 

PHONE_____________________________  Home       Cell

 

 

EMAIL ADDRESS___________________________________________________

 

 

SCHOOL ATTENDING_________________________________________________

 

 

CURRENT GRADE ________________

 

 

HAVE YOU EVER TAKEN AN ACT?     YES           NO

 

YES?  WHEN (Month/Year)_________________________

Please bring a score report printout from www.actstudent.org on the PreTest date if taken a previous ACT.

 

 

PAYMENT-----CHECK _________ (Make checks payable to ACT Summer Academy, LLC)     

                      CASH__________ 

 

MAIL YOUR REGISTRATION AND PAYMENT TO. . .  

 

ACT SUMMER ACADEMY

744 Forder Crossing

St. Louis, MO 63129

                      

You will receive an email confirmation when registration form and payment are received.