Consultation Form - K12
Complete this form then schedule a consultation appointment.
If you are an adult student seeking a tutor, please click here.
It's easy as Pi currently
only offers online tutoring sessions
.
Consultations are conducted via
Google Meets
.
Consultations are
not
tutoring sessions, but an opportunity for parents to discuss their needs.
Required
*
I acknowledge that I understand and agree to the above.
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Parent/Guardian Information
Parent Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Your Timezone
*
Please Select
Eastern
Central
Mountain
Pacific
Alaska
Hawaii-Aleutian
Preferred Method of Communication
*
Text
Call
Email
Relationship to student
*
Please Select
- myself -
parent
grandparent
other
Are you willing to commit to a weekly tutoring schedule?
*
Please Select
Yes
No
All students are required to commit to a consistent weekly schedule with a minimum of two (2) sessions per week.
Would you be okay with sharing a session with another student?
*
Please Select
yes
no
maybe
Please note that due to scheduling constraints we may not be able to accommodate single sessions.
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Student Information
Student Name
*
First Name
Last Name
Student Birthdate
/
Month
/
Day
Year
Date
Grade Level/Course
*
Please Select
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Pre-Algebra
Algebra 1
Geometry
Algebra 2/Trig.
Pre-Calculus
Other
Enrolled In?
*
Public
Private/Independent
Charter
Homeschool
Other
Student Email
Enables student to access their Student Portal.
Ideal Day(s) for Tutoring
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Flexible
Ideal Time(s) for Tutoring
*
2PM - 3PM
3PM - 4PM
4PM - 5PM
5PM - 6PM
6PM - 7PM
7PM - 8PM
8PM - 9PM
Flexible
Other
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Math Background
Current Numerical Math Grade
*
Please Select
100 - 90
89 - 90
79 - 70
69 - 60
Below 60
N/A
Math Grade in Previous Quarter
*
Please Select
100 - 90
89 - 80
79 - 70
69 - 60
Below 60
N/A
What is your child currently learning in math?
Enter N/A if unsure.
Area(s) for Concern:
*
Study Habits
Confidence
Poor Test/Quiz Grades
Anxiety (Testing or Math Related)
Homework
Missing Assignments
Learning Gaps
Basic Arithmetic
Attention Difficulties (ADHD/ADD)
Other
Has your child ever received educational accommodations under an IEP (Individualized Education Program), 504 plan, or other formal education plan?
*
Yes
No
Provide any additional pertinent information:
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Have you ever worked with a math tutor?
*
Yes
No
How would you rate your previous math tutor experience?
1
2
3
4
5
How did you hear about us?
Facebook
Instagram
Thumbtack
WyZant
NextDoor
Referral
TikTok
Internet Search
Other
Referral
First Name
Last Name
Referral Email
example@example.com
Follow us.
Status
Please Select
Complete
Missed
Notes from Consultation:
Tutor use only.
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