Last Name of Student First Name Middle Name

ACTive PREP Registration

This registration is for the prep class only. You must go to ACT.org to register for the test!!

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Last name of Student First name Middle name

Student’s cell phone Student’s Email

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Date of Birth Male/Female Age Current School & Grade Level

Date and score of any previous ACT tests ______

Parent Information

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Parent(s) or Guardian Name

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Home Address City State Zip

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Home Phone Work Phone Cell Phone

Parent’s Email

Sessions: Please check the session you would like to attend:

______ACTive Prep – Prepare for December 10, 2016 ACT – class is full – call for availability!

Sat. 11/5 Diagnostic Test 8:30-11:30AM Wed 11/9, 11/16, 11/30, 12/7

Sat 11/19 Full-Length Test 8:30-11:30AM Class 6:30-9:15PM

Sat 12/3 Full-Length Test 8:30-11:30AM Sun 11/20 Class 11:30AM-2:30PM

______ACTive Prep – Prepare for December 10, 2016 ACT – call for availability!

Sat. 11/5 Diagnostic Test 8:30-11:30AM Sun 11/6, 11/13, 11/20, 12/4

Sat 11/19 Full-Length Test 8:30-11:30AM Class 8:30-11:15AM

Sat 12/3 Full-Length Test 8:30-11:30AM Fri 12/2 Class 3:15-6:00PM

______ACTive Prep – Prepare for February 11, 2017 ACT

Sat 1/14 Diagnostic Test 8:30AM-11:30AM Wed 1/18, 1/25, 2/8

Sat 1/21 Full-Length Test 8:30-11:30AM Class 6:30-9:15PM

Sat 1/28 Full-Length Test 8:30-11:30AM Sun 1/15, 1/22 Class 8:30-11:15AM

______ACTive Prep – Prepare for February 28 or March 2017 IN SCHOOL ACT for Juniors **Class is Full –------Call for Availability or sign up for Feb 11th, April 8th, or June 10th class**

Sat 1/21 Diagnostic Test 8:30-11:30AM Wed 2/15, 2/22

Sat 2/11, 2/18 Class 8:30-11:30AM Class 6:30-9:15PM

Sat 2/25 Full-Length Test 8:30-11:30AM Sun 2/5, 2/26 Class 8:30-11:15AM

______ACTive Prep – Prepare for April 8, 2017 ACT

Sat. 3/18 Diagnostic Test 8:30-11:30AM Wed 3/22, 3/29, 4/5

Sat 3/25 Full-Length Test 8:30-11:30AM Class 6:30-9:15PM

Sat 4/1 Full-Length Test 8:30-11:30AM Sun 3/19, 3/26 Class 8:30-11:15AM

______ACTive Prep – Prepare for June 10, 2017 ACT

Wed 5/31 Diagnostic Test 8:30-11:30AM Thurs 6/1, Fri 6/2, Sun 6/4

Wed 6/7 Full-Length Test 8:30-11:30AM Mon 6/5, Tues 6/6, & Thurs 6/8 Class 8:30AM-11:15AM

FEE: $425 per session. Discount: Only $410 if registered at least one week prior to start (diagnostic test) date.

Please print and return form along with payment to:

Moving Minds ACTive PREP

Rhonda Noll

305 Artillery Park Drive Suite 101

Ft. Mitchell, KY 41017

This is also the class location –across from Ft. Mitchell Park!

Please make checks payable to: Moving Minds