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 Prep Jump Start Class - 10/04/2020 ($100.00)
ACT Prep Advanced Class - Starts 10/05/2020 ($680.00)
ACT Prep Jump Start Class - 10/11/2020 ($100.00)
ACT Prep Fundamentals Class - 10/12/2020 ($375.00)
ACT Prep Jump Start Class - 10/18/2020 ($100.00)
ACT Prep Fundamentals Class - 11/09/2020 ($375.00)
ACT Prep Advanced Class - Starts 11/10/2020 ($680.00)
ACT Prep Jump Start Class - 12/06/2020 ($100.00)

ACT Test date*

SAT Test date*

PSAT 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