| REGISTRATION FORM FOR SAT and/or ACT PREPARATION CLASSES, Spring, 2011 Mail registration form and check to Bender and Rocap Educational Services 941 E. 86th St. Suite #111 Indianapolis, IN 46240 STUDENT NAME__________________________________________________________________________ PARENT NAME _______________________________________________________________________________________ ADDRESS ________________________________________________________________________________________ ________________________________________________________________________________________ PARENT PHONE (H) ___________________________(c) ____________________________ STUDENT PHONE (H) ___________________________(c)___________________________ student email, if student checks email):___________________________________________________ For registration verification, please check your preferred method of contact: mail to home address as given above:_____ phone: ____________ (please realize a message may be left on voicemail or answering machine) parent e-mail: __________________________________ SCHOOL _________________________________________ Current English class:____________________ Current Math Class: _____________________ Please add test score information if you have it: PSAT: year____________ Critical Reading_______ Math_______ Writing_______ SAT: year ____________ Critical Reading_______ Math_______ Writing_______ Essay______ ACT: year ____________ Englsih_______ Math_______ Reading_______ Science_______ Essay______ Add any comments or questions: |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| REGISTRATION PAGE for SUMMER HSPT TEST PREP CLASS |
| Registrations will be recorded the day they are received. When the classes are full, registration will be closed. |