Total College Prep - Digital SAT/ACT Prep Private/Semi-Private Lesson Registration Form

Digital SAT/ACT Prep Private/Semi-Private Lesson Registration Form - ACH

Welcome to Total College Prep! Let's get started by enrolling your student in our private lessons today!

First Name

Last Name

Whom can we thank for referring you (Google, friend, organization, website, former client, etc.)?

Mobile Phone

Address

City

State

Zip

Payment Agreement I agree that my account/card will be charged $125/hour for each private lesson in office, $165/hour for each travel private lesson, $80/hour for each semi-private lesson, and $100/hour for each travel semi-private lesson. I understand that there is a cancellation fee of $125 if I fail to cancel my private lesson within 24 hours of its scheduled time. I understand that if I choose to pay with a credit card a 3% processing fee will be charged.

Payment Authorization I agree for Total College Prep to authorize regularly scheduled charges to my checking/savings account or credit card. I understand that if I choose to pay with a credit card a 3% processing fee will be charged. The rate for each private lesson is $125 per hour for lessons in office and $165 per hour for travel lessons. I understand that I will be charged a $100 curriculum fee upon my first private lesson. The rate for each semi-private lesson is $80 per hour and $100 per hour for each travel private lesson. A receipt for each payment will be provided to me. I understand that no prior notification will be provided unless the date or amount changes, in which case I will receive notice from TCP at least 10 days prior to the payment being collected. I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify Total College Prep in writing of any changes in my account information or termination of this authorization at least 30 days prior to the next billing date. If the above noted payment dates falls on a weekend or holiday, I understand that the payments may be executed on the next business day. For ACH debits to my checking/savings account, I understand that because these are electronic transactions, these funds may be withdrawn from my account as soon as the above noted periodic transaction dates. In the case of an ACH Transaction being rejected for Non-Sufficient Funds (NSF) I understand that Total College Prep may at its discretion attempt to process the charge again within 30 days, and agree to an additional $35 charge for each attempt returned NSF which will be initiated as a separate transaction from the authorized recurring payment. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. I certify that I am an authorized user of this bank account and will not dispute these scheduled transactions with my bank; so long as the transactions correspond to the terms indicated in this authorization form.

I would like to pay for my private/semi-private lessons with:

ACH - Bank Details

Credit Card/ACH- Your Billing Address, City, State, Zip

ACH - Name on the account

ACH Routing Number

ACH Account Number

Cancellation Policy - You may cancel or reschedule, at no additional cost, any session as long as you notify us by email at least 24 hours before your scheduled session. A $100 fee will be charged for cancellations made with less than 24 hours notice.

I would like my private lessons to be at the following location:

I would like my semi-private lessons to be at the following location:

Text Opt-In/Opt-Out By providing your phone number, you consent to receiving text messages to confirm your lesson time/date or to communicate schedule changes. You may opt-out at any time by texting “STOP” to 972-587-5005. Message and data rates may apply.

For which test are you preparing?

Digital SAT curriculum monthly fee (REQUIRED for all group class students & private SAT students) I understand that I will pay for curriculum on a month-by-month basis of $30/month directly to the curriculum company.

ACT curriculum fee Private lessons only--I understand that I will be charged a flat fee of $100 for access to digital SAT and ACT practice tests.

I understand I will need to pay $150 for the practice test platform once the classes are complete in order to master the content, timing, and strategies that my student has learned during the lessons. This package includes 16 tests plus review sessions.

Student

First Name

Last Name

Mobile Phone

School Name

In what year will you be graduating?

Previous Testing Experience

My previous PSAT, SAT or ACT score(s) to report are:

Do you have a learning difference or health issue that impacts your learning? If yes, please explain.

Do you get extended testing time? If so, how much (ex: 1.5x or 2x)

What type of classes do you take?

Current Math Course

How would you best describe your learning style?

Is there anything additional about you that we should know?

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