Enhanced Learning Services is geared to helping your child reach his/her full potential. We strive to ensure that your child is getting the best services in order to enhance their thinking, reading and writing skills. Upon completing this form, you will receive a phone call to discuss services. I look forward to hearing from you.
RATES
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1:1 Virtual Sessions @ 1 hour, $40.00
SEL Learning/ Children Counseling Services @ 45 minutes, $30.00
IEP Review/ Consultation @ 60 minutes, $60.00
TODAY'S DATE
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Month
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Day
Year
Date
STUDENT NAME
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First Name
Last Name
Date of Birth/ Current Age
STUDENT GRADE LEVEL
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GRADE
PARENT/ GUARDIAN
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First Name
Last Name
PHONE NUMBER
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Please enter a valid phone number.
Format: (000) 000-0000.
EMAIL
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example@example.com
IN CASE OF EMERGENCY CONTACT
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First Name
Last Name
PHONE NUMBER
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Please enter a valid phone number.
Format: (000) 000-0000.
EMAIL
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example@example.com
ACADEMIC AREA(S) IN NEED OF ATTENTION
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READING (K-6)
MATH (K-6)
SKILL BUILDING
HOMEWORK HELP (K-6)
INDIVIDUAL EDUCATION PLAN SUPPORT/GOAL ACHIEVEMENT
1:1 SOCIAL EMOTIONAL LEARNING/CHILDREN COUNSELING SERVICES
DOES YOUR CHILD HAVE AN INDIVIDUALIZED EDCUATION PLAN (IEP)?
Yes
No
BRIEF DESCRPITION OF AREA OF NEED
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ANY SPECIAL ACCOMMODATIONS YOU'D LIKE TO SHARE CONCERNING THE STUDENT (ALLERGIES, BREAK-TIME, EASILY FRUSTRATED)
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BEST TIME TO CALL?
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Signature
Submit
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