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Class Registration
Welcome to Elmahaba Center's class registration form.
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1
Student Name
*
This field is required.
First Name
Middle Name (Optional)
Last Name
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2
Birth Date
*
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Month
Day
Year
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3
Student Gender
Please Select
Male
Female
N/A
Please Select
Please Select
Male
Female
N/A
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4
Student Address
*
This field is required.
We need this to deliver supplies for the course. Please accurately put information in.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Afghanistan
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American Samoa
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Antigua and Barbuda
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The Bahamas
Bahrain
Bangladesh
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Belgium
Belize
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Chad
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China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
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Democratic Republic of the Congo
Denmark
Djibouti
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Dominican Republic
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Egypt
El Salvador
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Eritrea
Estonia
Ethiopia
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Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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5
Student E-mail
*
This field is required.
To share our google docs and resources with you, we'll need your email.
example@example.com
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6
Student Mobile Number
*
This field is required.
By giving us your phone number, you are consenting to be a part of our regular text messaging reminders about when tutoring starts, any college events or general community events happening, etc. If you do NOT consent, write in: 000-000-0000
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7
School Student Attends Currently
*
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8
Grade Level
*
This field is required.
Tutoring is open to all high schoolers. ACT Class is only open for 10th and 11th graders. College Prep Course is only open to 11th graders.
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9
Name
*
This field is required.
First Name
Last Name
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10
Relationship to student
*
This field is required.
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11
Phone Number
*
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Please enter a valid phone number.
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12
Email
*
This field is required.
example@example.com
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13
What the name of THE CHILD's doctor?
*
This field is required.
In case of emergency
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14
What is the phone number of the CHILD's doctor?
*
This field is required.
In case of emergency
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15
Courses
*
This field is required.
You can only choose one course per application.
Please Select
ACT Class
College Prep Course
Please Select
Please Select
ACT Class
College Prep Course
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16
Have you taken the ACT before?
*
This field is required.
YES
NO
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17
If so, WHEN did you take the ACT?
*
This field is required.
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18
What was your score?
*
This field is required.
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19
What subject do you need the most help in?
*
This field is required.
English: Reading Comprehension
English: Grammar
Math
Science
Writing
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20
Currently, have you signed up to take an ACT exam?
*
This field is required.
YES
NO
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21
If so, WHEN is the date of your ACT exam?
*
This field is required.
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22
How would you like your student to be tutored? (Only in-person students will receive dinner from 4:30-5 pm.)
Virtual on Zoom for the whole semester
In-person in the library
I can do both virtual and in-person.
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23
I understand that tutoring is only on Tuesdays and Fridays. There will be no makeup sessions guaranteed.
Yes, I understand
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24
I understand that there will be dinner provided on Tuesdays and Fridays from 4:30-5 pm for tutors and students for free in the library.
Yes, I understand
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25
Which classes do you need the most help in and why?
Please note that our tutors specialize in English--AP Lang and AP Lit, essay editing, grammar, etc. We can support you in other classes as well, but we're prioritizing English.
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26
Do you need any school supplies for tutoring? Any specific books?
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27
On average, Monday through Friday, how long do you spend on homework/studying?
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28
This tutoring application is for the next 12 weeks. After 12 weeks, you must re-fill this application to continue with us.
Yes, I accept
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29
What is your main concern about applying to schools this fall?
Essay, resume, college application, scholarships, financial aid, college visits, etc.
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30
Appointment
Please select a 15-minute time slot to speak to us about your college application.
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31
Currently, what is your GPA?
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32
Currently, what is your ACT score?
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33
Currently, was your grade/score in them?hat are the AP/IB/Dual Enrollment classes you've taken, AND what
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34
Additional Comments
Let us know what you want to explore in the class.
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35
File Upload
Please upload the essay or resume you'd like us to review.
Drag and drop files here
Select files to upload
Max. file size
: 10.6MB
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36
What's your level of education?
I'm in high school.
I'm in college (undergraduate).
I'm in college (graduate).
I'm not in school currently.
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37
What is the prompt for the essay?
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38
Specifically, for which class is this essay?
If it's an AP/IB/dual enrollment course, please specify that below.
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39
Upload your essay here.
Please make sure that the file is WORD DOCX, not a pdf, so that we can edit it on the page without printing and scanning.
Drag and drop files here
Select files to upload
Max. file size
: 10.6MB
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of
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40
I am allowing Elmahaba Center staff and volunteers to take pictures of me while in class for the purpose of social media and marketing for their non-profit efforts.
*
This field is required.
YES
NO
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41
Donation to Elmahaba
*
This field is required.
Because we are unable at this time to run our programming without fees, we require all students to donate a small amount to support our work for ALL students. Our donations are on a sliding scale, so PAY WHAT YOU CAN. Each course will come with its own handbook and supplies for you.
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After submitting the form, you will be redirected to the Google Pay to complete the payment process.
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After submitting the form, you will be redirected to the Apple Pay to complete the payment.
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