AIEP Registration Form

Registration Form

Arts Integrated Enrichment Program
Student's Name:
Birth Date

MonthDayYear
School
Grade Level
What is your greatest concern about your student's educational progress?
If the student is having academic obstacles, at what age did the problems begin?
Has the student been tutored in any academic areas before? If so, when?
Does the student have medical issues that may occur during tutoring?
Mother's Name:
Home/Cell Number
Please enter a valid phone number.
Email:
example@example.com
Father's Name:
Home/Cell Phone:
Email:
example@example.com
I have read and agreed to the Tutor/Parent/Student Partnership Agreement
Parent Signature(s):

Clear
Session Costs Per Student
prevnext( X )
Basic
1hour/per day for 5 days a week

$125.00 Quantity



Deluxe
3 hours/per day for 5 days a week

$375.00 Quantity



Unlimited (RECOMMENDED SAVINGS)
Unlimited hours/per day for 5 days a week

$275.00 Quantity



Total

$0.00
Should be Empty: