Tutor Application

Tutor Program Signup
Parent/Guardian Information
Parent/Guardian Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail Address*
Phone Number
Format: (000) 000-0000.
Child Information
Child Full Name*

First NameLast Name
Birth Date

MonthDayYear
MaleFemale
Child Grade-Level
Name of school
Academic Needs
Individualized education plan or behavior plan

Upload your child's IEP or 504 plan
File Upload

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Upload scholarship (only if applicable)

Upload information on scholarship
File Upload

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Equine Experience
Medical Information
Physician Name*

First NameLast Name
Physical Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Additional Medical Concerns
(Allergies, Medications, etc)
Signature

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Tutor Program Signup