This form is intended for customers who would like to purchase the 8-week ACT Stellar Program. The program offers 2 weekly sessions for the 8 weeks preceding your student’s test date. All sessions are 2 hours. The hourly rate of this program is $35.

Please complete this form to be matched with a TopScore Tutor. All ACT Tutors at TopScore Academy have a composite score of 34 or above. The total cost of the Stellar Program is $1160, which covers 32 hours of guided tutoring and the Official ACT Textbook 2023-2024. In advance of our planned lessons, you can choose to be billed in bi-weekly installments, monthly installments or pay in full. Instructions for payment processing will be shared following the completion of this form.

We accept credit and debit, or checks made payable to TopScore Academy LLC.

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Parent Name *

First

Last

Email *

Payment processing will be sent to this email address.

Address *

A TopScore Tutor will come to this address to deliver their lessons.

Student Name *

First

Last

Student Phone Number *

Primary communication from the student’s TopScore Tutor will be texted to this number.

Please Select Available Session Times When Your Student is Available *

• Monday 4-6 PM
• Monday 7-9 PM
• Tuesday 4-6 PM
• Tuesday 7-9 PM
• Wednesday 4-6 PM
• Wednesday 7-9 PM
• Thursday 4-6 PM
• Thursday 7-9 PM
• Friday 4-6 PM
• Friday 7-9 PM
• Saturday 9-11 AM
• Saturday 12-2 PM
• Saturday 3-5 PM
• Sunday 12-2 PM
• Sunday 3-5 PM

Please select time slots across at least 3 different days. Choose as many time slots as applicable, including multiple slots on the same day. Selecting more time slots tends to result in faster service.

Anticipated Testing Date *June 8July 13

Tutoring will begin 8 weeks in advance of your selected test date.

How Would You Like to Pay the $1,160 Charge? *

• In Full
• In Monthly Installments (Month 1: $600 | Month 2: $560)
• In Bi-Weekly Installments (Week 1: $320 | Week 3: $280 | Week 5: $280 | Week 7: $280)

Installments reflect the expected lessons for their respective period, with the first installment covering the Official ACT Textbook 2023-2024.

Questions for the TopScore Team

I Have Read the Statement Below and Agree *

• Agree
• Disagree

I attest and certify that this form acts as a verbal Client Agreement. I understand and accept that TopScore Academy LLC reserves the right to withhold service until payment is received and processed.

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