Tutoring & After School Programs Application Form

Tutoring Services
Application Form

Thank you for your interest in The Virtual Classroom!
We ask that you kindly complete the below form if you are interested in virtual or in-person tutoring services for your child in literacy and/or math.

Please give us a few days after submission to review and reach out with additional information.
Today's Date*

MonthDayYear
Date
Name of Student*

First NameLast Name
Student's Birthdate*

MonthDayYear
Date
Student's Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Student's School*
Student's Grade Level*
Type of instruction you are interested in for your student. Check all that apply.*

ReadingSpellingWritingMathIntervention (Below Grade Level Support)Enrichment (On or Above Grade Level Support)Remote InstructionOnsite Instruction: The Virtual Classroom Learning Center
How would your child get to the center for instruction?*
Parents are responsible for picking students up at the conclusion of lessons.
Intervention lessons occurs 2-3x a week depending on student needs. Enrichment lessons occurs 1-2x a week. Please select the days of the week that work best for your child's lessons below. Check all that apply.*

MondayTuesdayWednesdayThursdayFridayUnsure at this time
Kindly share the times that work best for your child's lessons below. *
Name of Parent/Guardian*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Share some information about your child below. What are their strengths and opportunities for growth? Why are you seeking support from the The Virtual Classroom?*
How did you hear about us?*
Should be Empty:

Tutoring Services

Application Form