ACT Registration ACT Prep Student Information Student Name(Required) First Last Grade(Required) Parent/Guardian Name(s)(Required)Student Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Student Phone(Required)Parent Phone(Required)Student Email(Required) Parent/Guardian Email(Required) Which ACT Prep Course will you be attending?(Required) List Prospective CollegesArea(s) of ConcernDate(s) You plan to take the test:Have you taken the ACT before?(Required) Yes No If you have taken the ACT before, list the following scores: Composite, English, Reading, Mathematics, and ScienceEmergency Contact Name First Last Emergency Contact Phone