Excellerate Post-Trial/Conference/Consultation Result Report

Director's email address* This field is required.Please use Excellerate email address

example@example.com

Student's Team* This field is required.

A - Chyna

B - Christie

C - Rachael

D - Lincolnshire

Other

Preferred Location after trial or this conference* This field is required.

Glenview

Lincolnshire

Online

Other - Student's own location

Parent's Name* This field is required.

First Name

Last Name

Parent's Email Address* This field is required.Only the main email in Active Campaign

example@example.com

Student's Full Name* This field is required.

First Name

Last Name

This student will continue after the trial/this quarter or consultation* This field is required.Click 'Yes' fore sure, 'Maybe' when parents say, 'Not sure. Let me talk to my family' or if they want us to follow up after certain time. 'No' if they want to withdraw. Not all enrichment classes will have a trial period unless it's a promotional period.

Yes

Maybe

Subject(s) student opted in to continue

Math

English

Writing - Tier 1

Writing - Tier 2

Writing - Tier 3

Coding & Creative Projects

Lego Robotics

Critical Math for Creative Minds

ACT Prep

SAT Prep

PSAT Prep

College Planning Roadmap

1:1 Academic/Subject Coaching

Contract Type

Quarterly

Yearly (monthly payment with 10% discount is available)

Monthly (HS Core or Enrichment - Writing, Coding, or Robotics or 1:1)

Robotics (Semester)

Roadmap for College 9-10

Roadmap for College 11-12

Test Prep 1:1

Is the student going to do writing class in lieu of English in Group Core?

YESNO

Is the student going to do this STEM class in lieu of Math in Group Core?

YESNO

Has the student taken ACT or SAT

Please provide previous ACT, SAT, or PSAT score(s)Example: July 2021 ACT Composite 29, E29, M29, R29, S29 August 2021 SAT Composite 1400 E/R 700, M 700

Does this student have accommodation for extended time approved by ACT or SAT?

Yes

Which math class has this student taken last year, is currently taking, or will be taking next year?

Which test prep option?

Preferred day and time of class for Group Core Academic

Preferred day and time of class for Test Prep

Applicable discount

Group Core Yearly discount (10%)

Any Group (Core, Enrichment, or Test Prep) Referral ($30/subject, one time)

Group Core or Enrichment Sibling discount ($15/subject, second child or more)

Group Core Year 1 discount ($25/subject)

Group Core Year 2 discount ($100/subject)

Group Core Year 3 discount (a whole month tuition)

1:1 Services ($50/subject)

Family and friends 25%

Teacher's family discount (additional) 10%

First responder/Active-duty military discount (additional) 15%

Other

Expected starting date

Date

Next conference or follow-up date

Date

Accounts to close

RBM

RBL

ALEKS

Kodable

Director's comment* This field is required.

Next date to follow-up

Date

Director's comment for the curriculum* This field is required.

Director's comment for operations* This field is required.TB & All Studio Sheets

Accounts to close

RBM

RBL

ALEKS

Kodable

Excellerate Post-Trial/Conference/Consultation Result Report