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Peer Power's ACT Kickoff and Parent Orientation
(It is mandatory for a parent/guardian to attend one of the following sessions. Students are welcome to participate as well.)
Date: March 4 (In-person at the University of Memphis or 6 (Virtual)
Time: 5:30 pm to 6:30 pm

Peer Power's ACT Prep University
Camp Dates: March 11-15, 2024
Times: 8:00 am to 3:00 pm
Location: University of Memphis

More details will be provided via email.

Please fill out the below form in its entirety to register! Be on the lookout for email updates leading up to camp.

Note: Due to limited capacity, high school juniors and those registered for the April 13th national ACT will be admitted with priority. For more information about registering for this test, please refer to www.act.org, your guidance counselor, or email act@peerpowerfoundation.org.

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* 1. Applicant Name

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* 2. What is your birthday?

Date

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* 3. Personal e-mail address (not a MSCS student e-mail)

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* 4. Phone Number

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* 5. Home Address

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* 6. What is your gender identity?

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* 7. Ethnicity (Select all that apply)

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* 8. Please list any food allergies or dietary restrictions.

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* 9. Emergency Contact: Name

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* 10. Emergency Contact: Email

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* 11. Emergency Contact: Phone number

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* 12. Relationship to Emergency Contact

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* 13. What school do you attend?

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* 14. If you don't see your school above, please type the name of your school.

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* 15. What grade are you in?

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* 16. Power School ID

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* 17. How did you hear about this program?

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* 18. Have you previously attended a Peer Power ACT Prep Camp?

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* 19. Do you need transportation to or from this camp?

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* 20. If yes, from which location below?

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* 21. By registering for this program, I understand that I am committing to attend every session AND that a parent/guardian will attend one of the parent orientation dates to review the details of the program and sign the required paperwork.

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* 22. Which parent/guardian option would you like to choose?

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* 23. Have you registered for the official ACT test on April 13th or are you taking a school-sponsored ACT test for juniors in March?

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* 24. Please upload an image of your ACT admission ticket or your registration confirmation page. Registration Confirmation Example

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
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