Total College Prep - Total College Prep Registration Form

Total College Prep Registration Form - Canvas (CC)

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

First Name (Parent)

Last Name (Parent)

Email (Parent)

Mobile Phone (Parent)

Address

City

Would you like to add a private lesson package to your group class (each private lesson is one hour in length)?

Payment

Credit Card Details

You may pay using a Credit Card or an ACH account. Please fill in the payment information below. Please note that a 3% service charge will be applied to all CC transactions.

By submitting your credit card, you consent the initiation of payments on your behalf for services we provide to you.

Payment Terms: I agree for Total College Prep to authorize regularly scheduled charges to my checking/savings account or credit card if I choose to pay my tuition in installments. I understand that if I choose to pay with a credit card a 3% processing fee will be charged. 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 fall 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debits to my checking/savings account, I understand that because these are electronic transactions, these funds may be withdrawn from my account as soon as the above noted periodic transaction dates.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.

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

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.

Student

First Name

Last Name

Mobile Phone

School

Graduation Year

How would you best describe your learning style?

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

Do you get extended testing time?

What type of classes do you take?

What math course are you currently enrolled in?

Previous Testing Experience

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

In what year will your student be graduating?

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Add Fields for Additional Student