Tutor Request Form - CONFIDENTIAL

Tutor Request Form - CONFIDENTIAL

Complete this form for a FREE consultation.
Student's Name

First NameLast Name
Gender

MaleFemaleNon-binary
Birth Date

MonthDayYear
How would you like tutoring to occur?
Subject for tutoring
Grade
Contact Information
Parent's Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
E-mail
example@example.com
Student E-mail (optional)
example@example.com
Please respond to the following prompts with as much detail as possible. Please know that your responses are non-binding. We can always adjust!
Which statement applies best?

My child will benefit most from tutoring that occurs on a regular basis.My child will benefit most from tutoring on an as-needed basis, focusing on specific challenges they encounter with the subject matter.
Please describe your child's strengths.
Please describe your areas of concern for your child.
What days of the week work best? (The more options, the more tutoring candidates we can provide.)
What time of day?
How long should each session be?
How many sessions per week?
How many hours of tutoring do you think you might purchase?
0-9 Hours: $130/HR; 10-14 Hours: $125/HR; 15-19 Hours: $120/HR; 20-24 Hours: $115/HR; 25-29 Hours: $110/HR; 30+ Hours: $105/HR; Learning Specialists: $150/HR
What type of energy does your child respond to during moments of academic support?

Lots of Energy!Even Keel, Chill, Low Key.
Would you like to schedule a phone call to further discuss your child's tutoring plan? If so, please share some days and times that work for you.
Is there anything else you wish to share about your child?
How did you hear about us?

Referral from a friendReferral from schoolWeb searchFacebookLinkedInOther
Thank you for completing this form! We will be in touch with you soon with great tutoring candidates for your child. Please allow 1-2 business days.
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Tutor Request Form - CONFIDENTIAL

Contact Information

Please respond to the following prompts with as much detail as possible. Please know that your responses are non-binding. We can always adjust!