Mally A.C.T.


Mally A.C.T. Workshop Registration. Please fill out the forum below and when finished click submit (Please click submit only once). You will then be taken to the payment page. If you require assistance filling out this form please contact us by phone at 248-78-TUTOR.

Mally A.C.T. Workshop Registration

Student Name:
Student Address:
Student City, Zip Code:
Student Phone Number:
Student Cell Phone Number:
Student Email Address:
Student School:
Student Grade:
Student PLAN/Most Recent ACT Score:
Are you entitled to special accomodations for this test (ie: 504 plan)? If so, what?:
Parent Name:
Parent Address:
Parent City, Zip:
Parent Phone Number:
Parent Cell Phone Number:
Parent Email Address:
Workshop Date:
How did you find out about Mally A.C.T. and our workshops? (Select All That Apply):
 

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