Building Knowledge Everyday Student Info Form

Student Registration Form

Fill out the form carefully for registration
Student Name*

First NameLast Name
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Gender*
Birth Date

MonthDayYear
Client E-mail*
Primary Phone Number*

Area CodePhone Number
Secondary Phone Number

Area CodePhone Number
Tutoring Information
Subject Area For Which You are receiving Tutoring*
Tutoring Objectives-What is the objective of your Tutoring? (Select all that apply)*

Remedial InstructionExam PreparationSubject MasteryLearning Study Skills
Frequency-How often would you like to meet with a tutor?*

Once a weekTwice WeeklyMore than Twice a WeekOnce Every Two Weeks
If you are preparing for an upcoming standardized test (e.g. SAT), please enter the date of the upcoming exam below.
Date

MonthDayYear
Comments or Concerns- Is there anything else we need to know?
If you have accurately and completely filled out this form, then please click "Submit" below. Thank you!
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Student Registration Form