ACT Tutoring Registration Form Focus On Learning 200 Corporate Lake Drive Columbia, Mo 65203 (417) 344-7055 (Office) (573) 239-4074 (Cell) * RequiredParent/Guardian Name* First Last Email* Address* 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 Phone*Student's Name* First Last School* Year of Graduation* How did you hear about us? Web search Digital ad Email flyers Word of Mouth ACT 1-1 Tutoring* English Reading Writing Math Science ACT Date* April 15th, 2023 June 10, 2023 July 15, 2023 September 9, 2023 October 28, 2023 December 9, 2023 Have you taken the ACT before?* Yes No What has been your highest score?*What is your goal score for the ACT?*Date of last test Is there a college you are trying to qualify for?*CAPTCHA Δ