Shoresh Learning
Registration
Clients Information
Clients Information
First name
Last name
M.I.
Grade level
Email address
Services needed
Male or female?
Female
Male
Hours of service required (Choose a slot)
Half hour (one day a week)
Full hour (one day a week)
Half hour (two days a week)
Full hour (two days a week)
Other
Days of the week requested
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
What time works best for you?
Before 12:00 p.m.
After 12:00p.m.
Parent's Information
Parent's/Guardian's name
Phone number
Email address
Needs assessment
Are you currently enrolled in a Math Course?
If so, what class are you currently taking?
Are you currently doing E-Learning for school?
How are you handling E-Learning?
Are you needing assistance with ACT/SAT prep?
If so, What test are you planning to take? When?
Do you simply plan to brush up on Math?
If so, What area are you most interested in?
Is there anything else you'd like to add to help us better assist you?
Computer access
Do you have access to a computer/tablet/etc?
Do you have access to Internet?
Please list any additional information that you feel we may need to provide you with the best of service.
Submit
Type a question
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