Tutoring Consultation
Complete this form then schedule a consultation appointment.
Services Requested
*
Please Select
Math Tutoring
Test Prep
Easy as Pi currently
only offers online tutoring sessions
.
Consultations are conducted via
Google Meets or by phone
.
Consultations are
not
tutoring sessions, but an opportunity to discuss your needs.
There is no obligation to commit to tutoring after the consultation.
Required
*
I acknowledge that I understand and agree to the above.
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Student Information
Relationship to Student
*
Please Select
- myself -
parent
grandparent
other
Student
*
First Name
Last Name
Parent/Guardian
*
First Name
Last Name
Email
*
example@example.com
Phone
*
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
Timezone
*
Please Select
Eastern
Central
Mountain
Pacific
Alaska
Hawaii-Aleutian
Preferred Method of Communication
*
Text
Call
Email
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{student}'s Birthdate
/
Month
/
Day
Year
Date
Grade/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
Calculus I
Other
Enrolled In?
*
Public
Private/Independent
Charter
Homeschool
Other
{student}'s Email
Enables student to access their Student Portal.
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Preferred Start Date:
-
Month
-
Day
Year
Date
Preferred Tutoring Times
*
Flexible
2PM - 3PM
3PM - 4PM
4PM - 5PM
5PM - 6PM
6PM - 7PM
7PM - 8PM
8PM - 9PM
Other
Preferred Tutoring Days:
*
Flexible
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Are you willing to commit to a weekly tutoring schedule?
*
Please Select
Yes - Twice per week.
Yes - Once a week.
No
Are you willing to share a session with another student?
*
Please Select
No
Maybe
Yes
Please note that due to scheduling constraints we may not be able to accommodate single student sessions.
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Testing Information
Preparing for (SAT, ACT, Praxis, etc.)
*
Please Select
SAT
ACT
SSAT/ISEE
Praxis Core: Math (5733)
Praxis Content: Mathematics (5165)
Has Student Taken this Test Before?
*
Please Select
No
Yes
If yes, please provide the most recent score:
Test Date (if scheduled):
-
Month
-
Day
Year
Date
Upload Available Score Report(s)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
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Academic Background
Current Grade
*
Please Select
100 - 90
89 - 90
79 - 70
69 - 60
Below 60
N/A
Previous Quarter Grade
*
Please Select
100 - 90
89 - 80
79 - 70
69 - 60
Below 60
N/A
Currently Learning
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
Testing Concern(s):
*
Content
Time Management/Pacing
Testing Strageties
Other
Any Learning Accommodations (e.g., IEP, 504 Plan)?
*
No
Yes
Additional Information About Learning Style or Needs:
Notes from Consultation:
Tutor use only.
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Previously worked with a tutor?
*
No
Yes
Rate previous tutoring experience. (1 = poor, 5 = excellent)
1
2
3
4
5
How did you hear about us?
*
Social Media
Thumbtack
Referral
Internet Search (ie. Google)
Guidance Counselor
Other
Referral Email
example@example.com
Referral
First Name
Last Name
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