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* = Required Info

If you have questions or problems with this form, text 205-970-1117.

Hello! We're glad you're interested in our ACT prep course. To enroll your student, all you need to do is 1) submit this complete registration form, and 2) submit the registration fee (you'll see a link to our payment page after you submit this form).

If you're enrolling multiple students, you'll need to fill out this form separately for each student.

If your student only needs help improving their scores in one or two of the ACT sections, please let us know by typing the names of the sections and your preferred session dates in one of the text boxes below.

Basic Info

* Student's First Name:

* Student's Last Name:

* Gender:       Male       Female

* School:

* Graduation Year:

* Parent/Guardian's Full Name:

* Home Address:

Home Address Line 2:

* Zip Code:

* Phone:

* Can you receive texts to the above phone number?       Yes       No

Alternate Phone:

* Student's Phone:

* Parent/Guardian's Email:

* Student's Email:


Referred By:

*Has your student received ACT prep in the past? If so, who was it with and what was their experience like?


ACT Info

Please share the scores from the test on which your student got the highest composite score. This information can be found on your ACT score report.

* How many times has your student taken the ACT?

Month and Year of Test with the Highest Composite Score

ACT ENGLISH Section Score (on highest scoring test)

ACT MATH Section Score (on highest scoring test)

ACT READING Section Score (on highest scoring test)

ACT SCIENCE Section Score (on highest scoring test)

ACT COMPOSITE Score (on highest scoring test)

Extended Time

The ACT allows students with documented disabilities to get 50% more time on the test. If this applies to your student, we HIGHLY recommend that you apply for extended time. Click here for more information.



Our course has 4 weekend time slots. Rank the times that work for your student between now and the test date, or indicate which times won't work at all. Each class is 3 hours long. Please choose the times that you're sure your student will be able to attend all 4 weeks. Make sure the times you choose match the hours of your preferred meeting place.

Which ACT test date is your student planning to take (example: "February 2019")?

* What date would you like to start the course (we recommend a month before the test)?





If your student isn't available during one or more of the weekend times, what weekday times work for them on a regular basis?

If your student won't be available during all of the days in your choices above, which dates won't they be available?

There's a rescheduling fee equal to the registration fee for ANY rescheduling request (excluding sickness or family emergency) that we receive AFTER the start of the course. Please look at your family's calendar and student's schedule now so you aren't charged this fee.

Meeting Place

YOUR MEETING PLACE MUST BE WITHIN THE FOLLOWING RADIUS! Most students prefer to be tutored at home, but we can also meet at a public meeting place. If you choose a library, your course time may need to be adjusted to fit the library's hours (we'll contact you via email). If you want to make sure this doesn't happen, google the library hours before submitting this form.



IMPORTANT: By checking the box below and clicking "Submit," you acknowledge that Masterminds Tutoring does not and cannot guarantee any particular score or score increase on your student's future ACT tests as a result of this course; in addition, you agree to 1) pay for each session at least an hour before the session (if we don't receive payment on time, we'll have to postpone the session until we receive it), 2) pay a rescheduling fee (equal to the registration fee) for all rescheduling requests (excluding sickness or family emergency) that you make AFTER the start of the course, and 3) pay a no-show fee (equal to the registration fee) if your student fails to show up to a scheduled class without you notifying us ahead of time.

* By checking this box, I acknowledge that I've read the above policies, I understand them, and I agree to abide by them.