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 Name
Last Name
Parent/Guardian Name
First Name
Last 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
Female
Male
Transgender
Non-binary/non-conforming
Prefer not to respond
Other
Grade Level of Student
Please Select
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Other
Content needing tutoring services
K-8 Math
Language Arts/English
Social Studies/History
K-8 Science
Chemistry
Physics
Biology
Environmental Science
Math 1
Math 2
Math 3
Math 4
Precalculus/Calculus
Other
What time of day are you wanting tutoring for your student?
Please Select
Morning
Afternoon
Evening
Open to availability
What days per week are you available? (check all that apply)
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
What is your preference on gender of the tutor?
Please Select
Female
Male
No Preference
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.
Continue
Continue
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