Educational Talent Search

Request for ACT Registration Fee Assistance

(To be completed by the ETS student)

Student Name______School______

Address______City______State______Zip Code______

Social Security # (required)______Grade______Email Address:______

Phone: (Home) ______(Cell) ______

You must complete and fax or mail this form to ETS for approval. Do not mail ACT registration materials until ETS approval has been granted. You will be notified within four business days upon ETS receiving your request. ETS will mail the Waiver form to you to mail with your registration. Do not wait until the week before the test deadline to complete this form if you would like assistance as ETS needs processing time of 48 hours.

Requirements for Requesting Fee Assistance

Low Income Eligibility

Completed Access to Records form on file at ETS or with this request

Current Transcript on file at ETS or with this request

ETS reserves the right to deny fee waivers if prep coursework has not been completed or grades don’t meet minimum of 2.0 GPA. ETS asks that you have ACT results sent to them as well as colleges of your choice. ETS Code is 6974.

1.  ACT Test Information:

a.  Test Date

b.  Test Location

c.  Registration Deadline

2.  Have you taken the ACT before? Yes No (circle one)

If yes, what was your score?

Which colleges/universities are you sending your ACT results to?

What are your career plans?

3.  What is your: Current GPA Class Rank # out of . (required)

4. My plans to prepare for ACT include: (A) Prep Workshop (B) Practice Test (provided in Preparing Booklet in registration packet). (Circle each that applies)

I agree to notify Educational Talent Search with my ACT results.

Student Signature Date

►►NOTE: If this request is approved, you will receive a printed waiver from ETS that contains a

serial number in the upper right hand corner. This serial number is valid for registration

via mail or on the web.◄◄

------ETS Office Use Only: AD Received in ETS

Approved Denied

If Approved: Waiver Sent to Student Date Verification Type______

Rev. 12/08 CAM