ACT Registration Form

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ACT Registration Form

Instructors Section
For Instructor's use
No more than one ACT reports to an individual certified Technician
Course selection
Please check the course(s) in which you are placing the student.
Prerequisite for ACT-HMA (only): ACT Aggregate course
  • The director or designee of HTCP will grade the exam and send an I.D. card to the student upon successful completion of the program.
  • NO REFUNDS  - The fees for ACT Program course materials will not be refunded once the materials have been mailed to the ACT course instructor/certified technician.
  • Please make check or money order payable to UW-Platteville/HTCP
  • Credit cards are not accepted for this program. 

Mail payment to:

1 University Plz
Platteville WI 53818-3099

or fax registration form to
Fax: 608.342.1982

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