Apply For Private Learning Superstars Program
Thank you for taking the time to fill out this form to work with Ms. Schelzi. The Private Learning Superstars Program is for students looking to fill in the holes in their foundational skills and boost their confidence with their overall relationship to learning! 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, we will contact you with next steps via email. Thank you for reaching out!
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
Child's Birthday
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Month
-
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 School:
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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 Skills
Peer Comparison
Momentum with Learning/Attitude Towards School
Writing Stamina
Other
If "other" please explain.
Does your child currently receive academic support?
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Yes
No
If you answered yes above, please explain the services provided and the frequency of services.
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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 themselves as a learner?
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Yes
No
In 2-3 sentences please share why supporting your child with their relationship with learning is important at this time?
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In 2-3 sentences please explain the specific areas of learning that you would like Ms. Schelzi to support your child with.
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Ms. Schelzi's Private Literacy Program is a 3 month commitment. Please share what SUCCESS looks like for your child in 3 months?
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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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At this time are you interested in...(check all that apply!)
Join Spring LITERACY FUNDAMENTALS - 6 week class for 1st & 2nd graders
Applying for Summer 2024 - I will be in touch early May with next steps for scheduling
I understand that working with Next Step Education is a 2x/week commitment for the summer. This is what is required for children to make adequate progress over time away from school in summer.
Got it! Ready to commit to 2x/week sessions
Not ready to commit to 2x/week sessions
Submit
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