Applying to ACT! Program

Fields with asterisk are required.

Student ID Number *
Please enter your date of birth (MM/DD/YY) *
List your state(s) of residency in the past 3 years *
Gender *
Racial Heritage *
Comments
Agreement *: By submitting this payment, I hereby agree to authorize the processing of my criminal background check report to meet the requirements of the program. This authorization, in original or electronic form, will be valid for any reports that may be requested by the college.

$10.40

Qty: