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Which IQ Diagnostic ACT do you plan to attend? (check boxes)
Diagnostic
     
Select the course you wish to attend:
 
     
Parent Name:
 
     
Student Name:
 
     
Street Address:
 
Street Address Line 2
 
     
City:
 
     
State:
 
     
Zip Code:
 
     
Parent's E-Mail:
 
     
Student's E-Mail:
 
     
Home Phone:
 
     
High School:
 
     
Current Year in High School:
 
     
Current ACT Cumulative Score if any): (1-36)
 
     
Current ACT English: (1-36)
 
     
Current ACT Math: (1-36)
 
     
Current ACT Reading: (1-36)
 
     
Current ACT Science Reasoning: (1-36)
 
     
Target ACT Score:
 
     
Universities/Colleges to which you plan to apply:
 
     
Current Cumulative High School GPA:
 
     
Would you be able to attend class on weekend days/weekend evenings/weekday evenings?
 
     
Additional comments
 
:
(Ex: Have you taken an ACT prep class before? Does your school offer an ACT class? Do you have any special circumstances that need accommodating?)
     
   
 
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