Tutoring Application
Please complete thoroughly
Student's Name
*
First Name
Last Name
Pronouns
*
He, him, his
She, her, hers
Other
Age
*
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Language spoken at home
*
Please Select
English
French
Arabic
Mandarin
Chinese
Spanish
Other
Select areas of tutoring needed (check all that apply)
*
Literacy (Reading & Writing)
Homework Help
Executive Functioning (organization, focus, study skills, etc.)
Kindergarten Readiness
Math
Other
Tutoring Preference
*
Individual (private tutoring)
Group
Either
Tutoring Preference (setting)
*
Virtual (online tutoring via Zoom)
In-person (Must be in Chicagoland area)
Hybrid (Both)
Schooling option this year
*
In school (public or private)
Home Schooling
Other
Current Grade Level
*
Please Select
Pre-K
Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
School (If student attends school)
Tell us about your child's strengths. What do they enjoy? (In school and outside of school)
*
Tell us about your child's academic challenges. (When did they start? What do they look like? Any other details we should know?)
*
Does your child have a documented disablility? (IEP/ 504)
*
Yes
No
Not Sure
If yes, please describe.
Contact Information
Par
E-mail
*
Guardian's Name
*
First Name
Last Name
Phone Number 1
*
-
Area Code
Phone Number
Phone Number 2
-
Area Code
Phone Number
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What is your preferred way of communicating?
*
Please Select
Phone
Email
Text
All the above
What are the best days and times to complete our initial call? (About 15-20 minutes is needed.)
*
How did you hear about our services
*
Please Select
Facebook
Search engine
Street ads
Parent/Friend referral
Other
Are you applying for our 2024 Summer Programming?
Yes!
No
No, but I would like more information
Submit
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