Tutoring Intake Form

Tutoring Intake Form

The following information will not be shared publicly and is for the sole purpose of communicating and providing the best services to you. A small deposit will be collected to hold your appointment time. If you move forward with tutoring services, this deposit will be taken off of your first session cost.
Name of Student

First NameLast Name
Parent/Guardian Name

First NameLast Name
Parent/Guardian Phone Number
Please enter a valid phone number.
Parent/Guardian Email
example@example.com
Age of the student
Gender of the student

FemaleMaleTransgenderNon-binary/non-conformingPrefer not to respondOther
Grade Level of Student
Content needing tutoring services

K-8 MathLanguage Arts/EnglishSocial Studies/HistoryK-8 ScienceChemistryPhysicsBiologyEnvironmental ScienceMath 1Math 2Math 3Math 4Precalculus/CalculusOther
What time of day are you wanting tutoring for your student?
What days per week are you available? (check all that apply)

SundayMondayTuesdayWednesdayThursdayFridaySaturday
What is your preference on gender of the tutor?
In some detail please describe the tutoring needs so we can best place the student.
Intake Appointment Scheduling
By signing you are agreeing to meet with the Head of Tutoring Services at the designated time.

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