Student Registration Form - Focus on Learning

Focus On Learning
3610 Buttonwood Drive #200
Columbia, MO 65201
(573) 886-8969 (Office)
* Required

Student's Name*

First Last

Student Phone

School*

Student Email

Year of Graduation*

I am interested in*

ACT 1-1 Tutoring*

PSAT Tutoring*

SAT Tutoring*

ACT Prep Classes*

ACT Test date*

PSAT Test date*

SAT Test date*

Have you taken the ACT/PSAT/SAT before?

What has been your highest score?*

Prior ACT/PSAT/SAT tests score break down

What is your goal score for the ACT/PSAT/SAT?

Date of last test

MM

DD

YYYY

Are there scholarships you are aiming for?*

What college(s) are you interested

I am interested in tutoring for these subject*

Student Registration