Georgia Milestones/”End of Course Test” Preparation Registration Form

Please provide the following contact information:

Today's Date:	*
Student's Name:	*
Parent's Names:	*
Class Date:
Street Address	*
Address (cont.)
City	*
State/Province	*
Zip/Postal Code	*
Parent(s) Work Phone	*
Home Phone	*
E-mail	*

School Attending:	*
Grade (choose one):

Choose the type of course(s): College Prep Honors Gifted Advanced Placement

Course Title:	*
Current Course Average:	*
Textbook Title:	*

Choose the class times convenient for this student on each class day: Saturday: 10 a.m. - 1 p.m. Saturday: 2 p.m. - 5 p.m. Saturday: 6 p.m. - 9 p.m. Sunday: 1 p.m. - 4 p.m. Sunday: 5 p.m. - 8 p.m.

How did you hear about Total Learning Concepts?:	*

Contact Information