Rainbow River Tutoring Questionnaire Form

Rainbow River Tutoring Questionnaire Form
STUDENT INFORMATION
Student's Name

First NameLast Name
Student's Age
Student's Grade Level
Name of School
Is English your child's native language?

YesNo
If you answer no, please state native language your child speak
PARENTS INFORMATION
Parent's Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
City of Residence
ex. san jose
TUTORING PREFERENCES
Preferred location of tutoring:
Days of Week Available (check at least 2 days)

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Times Available
Number of hours per week
Available to begin?
LEARNING ASSESSMENT
What subject(s) is help needed?

WritingReadingMathArt
What goals do you have for your child?
Do you have any tips to share about working with your child?
Should be Empty: