Education and Youth Development
ULKC Project Ready - ACT Prep Registration
Destination Wealth Creation TM
ULKC Project Ready / ACT Prep Registration
Parent/Guardian First Name
Parent/Guardian Last Name
Parent/Guardian Mobile Phone
Parent/Guardian Work Phone
How did you hear about the ACT Now! Program?
Have you participated in this program before?
If yes, when?
Have you taken the ACT Test before?
If yes, please indicate test date and composite score
Do you have any dietary restrictions (i.e. vegetarian, allergies, etc)? Allergies: pollen, nuts, shellfish, wheat,corn, soy
Additional Comments (please list any special needs or issues of which our staff should be aware of)
Enrolled in a federal free or reduced-price lunch program at school?
Reside in a foster home, are a ward of the state, or homeless?
Family received low-income public assistance or lives in federally subsidized public housing?
Spam protection question: what is two plus four?