1. education
2. school

MLCCC Summer ACT Prep at Villanova University
Taught by Ivy Experience
7/27/2015 – 8/13/2015 (3-Weeks)
Application Form
4 days a week (Mon - Thu, 9 AM – 4 PM) 12 days in total
$1,350 if register by 5/17/2015, else $1,500
Teachers and curriculum from Ivy Experience
Minimum Enrollment Needed: 10
General Information
Name: ________________________________ Current Grade: ______ School: ____________________
Address: ___________________________________ City: _________________ State: ____ Zip: _____
Student’s E-mail: ________________________________ Student’s Cell #: _______________________
Parent’s Name: __________________________________ Parent’s Cell #: ________________________
Parent’s E-mail: _________________________________ Parent’s Work #: _______________________
Student’s Current Subjects in School
Level (circle one)
English Class in School: ___________________________ AP, Honor, College Prep, Academic, Regular
Math Class in School: _____________________________ AP, Honor, College Prep, Academic, Regular
Math Subjects Student Has Completed (please checkmark):
Algebra 2 ( ), Geometry ( ), Pre-Calculus ( ), Calculus AB (
), Calculus BC (
)
Tuition (Check one box, materials fee included in tuition):
□ $1,350 if full payment by 5/17/2015
or
□ $1,500 if full payment after 5/17/2015
Please complete this registration form and mail it with payment to:
Main Line Chinese Culture Center, P.O. Box 94, Wynnewood, PA 19096
About Ivy Experience: Founded by U Penn graduates, Ivy Experience has been a college and test prep leader in
the Greater Philadelphia community. Energetic, up-to-date, and responsive, Ivy Experience has helped hundreds of
students raise their scores for the ACT, which is now the most taken college entrance exam in the United States.
Release of Liability:
In consideration of the activities at Villanova University, 800 E. Lancaster Avenue, Villanova, PA 19085,
sponsored by MLCCC, a nonprofit organization, I, the undersigned, understand and agree that the said MLCCC,
Ivy Experience, its officials, teachers, volunteers, and all teachers and staff, will not be held responsible for any
injury or accident sustained by any member of our party, or, for the loss of any property belonging to any member
of our party or anyone else.
MLCCC and Ivy Experience reserve the right to use students’ names and images in brochures and websites.
Parent/Guardian Name ___________________ Signature___________________ Date
_________
For more information, please visit www.mlccc.org, email [email protected], or call 215-490-6074 or 610-308-2624