Apply to learn w/ Next Step!
Thank you for taking the time to fill out this form to work with Next Step Education. Our Private Program is for K, 1st and 2nd grade students looking to fill in the holes in their FOUNDATIONAL reading skills and boost their CONFIDENCE! Getting your child on the right track with their learning now will set them up for continued academic success in the years to come! Working with Next Step Education does entail a financial investment that will set your child up for a confident tomorrow! Once you submit this form, I will be in touch to set up a Connection Call!
Your name
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First Name
Last Name
Your child's name
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First Name
Last Name
Child's Age
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Child's Birthday
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Month
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Day
Year
Date
Email
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example@example.com
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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Please enter a valid phone number.
Child's Current Grade:
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Child's Current School & Previous Schools Attended:
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What obstacles are preventing your child's growth? (Choose all that apply)
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Self Esteem/ Self Confidence
Holes in Foundational Literacy Skills
Peer Comparison
Momentum/Relationship with Learning
Writing Stamina
Other
If "other" please explain.
Does your child currently receive academic support or have they in the past school year?
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Yes
No
If you answered YES above, please explain the services provided and the frequency of services. This will help me best understand your child and their goals.
How important is it to you to build your child's CONFIDENCE with their learning?
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Not important
1
2
3
4
Extremely important
5
1 is Not important, 5 is Extremely important
How important is it to you to build your child's ACADEMIC FOUNDATION?
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Not important
1
2
3
4
Extremely important
5
1 is Not important, 5 is Extremely important
Are you willing to invest financially in your child's future?
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Yes - I understand investing in my child's future is important
Not at this time
Does your child need help gaining more self-confidence in themself as a learner?
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Yes
No
Please describe in 2-3 sentences please share why NOW is the time to support your child with their relationship with learning and foundational literacy skills.
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In 2-3 sentences please explain the SPECIFIC areas of literacy that you are seeing your child struggle with and would like Ms. Schelzi to support.
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What do you imagine SUCCESS to look like for your child in 3 months when they complete their private literacy program with Next Step.
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Anything else you would you like Ms. Schelzi to know?
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How did you learn about Next Step Education?
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Referral
Next Step Education Website
Facebook
Instagram
Other
If referral, who can we thank for spreading our mission?
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What type of LITERACY instruction are you interested in for fall?
VIP LEARNING - 1:1 Private Program - 2x/week for 30 min - open to K & 1st & 2nd graders
SMALL GROUP LEARNING - 1x/week for 45 min - open to 1st & 2nd graders
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