ACT State and District Testing Address Change Request

Please complete this form to request ACT to update address information within all ACT systems used for State and District testing including PearsonAccessnext. Personal home addresses will not be accepted.

*All fields are required unless otherwise noted.

Change of Address

Name of High School or District*

ACT High School or District Code*

Reason for Change*

Current Physical Street Address*

Current City*

Current State*

Current Zip Code*

New Physical Street Address*

New City*

New State*

New Zip Code*

First Name (Person Completing Form)*

Last Name (Person Completing Form)*

Phone Number

Email Address*

Role*

For which ACT product is this change being requested?*

Which administration is this change in regard to?

ACT State and District Testing Address Change Request

Form submitted successfully

Change of Address