Registration Form - Beechwood ACT Prep, Inc.
After submitting this electronic form, please check your email for the mailing address (2417 Ambrato Way, Fort Mitchell, KY 41017). If you don't see an email from Google Forms or an email from Beechwood ACT Prep, Inc., check your "Junk" or "Clutter" folders, especially if there are restrictions on your email server.
Once you submit your registration form, our mailing address (2417 Ambrato Way, Fort Mitchell, KY 41017) and our payment methods will also appear.
You will receive a Payment Confirmation email from
with all of the pertinent class information AFTER your payment is received.
Sign in to Google
to save your progress.
Please fill-out this registration form to let us know that you want to come to our class. However, your spot in the class is only secured with your payment. If we do not receive payment, we will contact you the week before the class starts to remind you to secure your spot with payment. We have a variety of accepted payment methods: check, money order, cash, and payment plans. Please read the email that you will receive upon completion of this form.
Please choose the SESSION that you would like receive 24 hours of ACT Prep - All Four Subjects
Session #43 IN-PERSON CLASS (Preparation for the December 2021 ACT Test)
Session #44 IN-PERSON CLASS (Preparation for the February 2022 ACT Test)
Session #45 IN-PERSON CLASS (Preparation for the April 2022 ACT Test)
Session #46 IN-PERSON CLASS (Preparation for the June 2022 ACT Test)
Session #47 IN-PERSON CLASS (Preparation for the July 2022 ACT Test)
Which scenario best describes your registration?
I am re-registering. I paid for and attended a session, but I did not take my scheduled test.
New Student ($500)
Returning 1X Student with score increase ($350)
Returning 2X Student with score increase ($200)
Returning 3X Student with score increase ($100)
Returning 4X Student with score increase (FREE)
Returning Student with NO SCORE INCREASE (FREE)
What is the student's last name?
What is the student's first name?
What high school does the student attend?
Boone Co HS
Bracken Co HS
Bishop Brossart HS
Calvary Christian HS
Campbell Co HS
Cov Cath HS
Cov Latin HS
Dixie Heights HS
Gallatin Co HS
Grant Co HS
Heritage Academy HS
Holy Cross HS
New Cath HS
Notre Dame Academy
Pendleton Co HS
Silver Grove HS
Simon Kenton HS
St. Henry HS
St. Ursuline Academy
St. Xavier HS
Summit Country Day HS
Villa Madonna Academy
Walnut Hills HS
What is the student's graduation year?
Class of 2022
Class of 2023
Class of 2024
Class of 2025
Parent/Guardian Email Address
Student Email Address
Parent/Guardian Phone Number Please enter using this format: (555) 555-5555
Student Phone Number Please enter using this format: (555) 555-5555
Page 1 of 3
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service