Academic and College Coaching
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Academic Advising - Pay as you go
per hour
$125.00
$
125.00
Number of Hours
1
2
3
4
Academic Advising - 5 hour Package
Expires 6 months
$500.00
$
500.00
Academic Advising - 10 hour package
Expired 12 months
$900.00
$
900.00
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
Student's Name
*
First Name
Last Name
Student Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Student Email
example@example.com
Grade
*
Numbers Only
School Name
*
Latest GPA / Percentile
*
Did the student receive any recognition, citation, or awards?
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Mother Name
*
First Name
Last Name
Mother Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Mother Email
*
example@example.com
Father Name
*
First Name
Last Name
Father Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Father Email
*
example@example.com
What are you looking for your child?
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MATH Assesment
English Assesment
College Application
SAT Prep
Guidance with choosing a major
Other
Which subject/Topic/Area?
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Please explain your concerns or the topic you would like to discuss
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Informed Consent
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Signer Name
*
First Name
Last Name
Signer Signature
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Date Signed
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Month
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Day
Year
Date
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