$79 / hour
Start Date:
*
-
Month
-
Day
Year
Registering for
*
TSI / TSIA Prep
SAT
Pre-Algebra
Algebra I
Algebra II
Geometry
Pre Calculus
Calculus
English
Other
Choose the Subject:
*
English
Math
English: Number of hours per weeks
*
Please Select
2 hrs - 1 Day per week
4 hrs - 2 Days per week
6 hrs - 3 Days per week
8 hrs - 4 Days per week
Math: Number of hours per weeks
*
Please Select
2 hrs - 1 Day per week
4 hrs - 2 Days per week
6 hrs - 3 Days per week
8 hrs - 4 Days per week
Choose your preferred date(s) for Math
*
Tuesday 6:00 pm - 7:00 pm
Thursday 6:00 pm - 7:00 pm
Other
Choose your preferred date(s) for English
*
Mondays 6:00 pm - 7:00 pm
Wednesday 6:00 pm - 7:00 pm
Other
Student's Full Name
*
First Name
Last Name
Student Date of Birth
-
Month
-
Day
Year
Date of Birth
Grade
*
Please Select
7
8
9
10
11
12
Student Email (Non-School)
*
example@example.com
Student's Cell
*
Please enter a valid phone number.
School Info
*
School Name
School District
Mother Full Name
*
First Name
Last Name
Mother Email
*
example@example.com
Mother Phone Number
*
Please enter a valid phone number.
Father Full Name
*
First Name
Last Name
Father Email
*
example@example.com
Father Phone Number
*
Please enter a valid phone number.
PAYMENT
Your card will be auto charged for the hours used (If the hours exceed the Package)
*
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10 Hours Package
$
650.00
20 Hours Package
$
1,000.00
Quantity
1
2
3
4
5
6
7
8
9
10
30 hours Package
$
1,350.00
Quantity
1
2
3
4
5
6
7
8
9
10
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Enrollment Agreement
Signature
*
Date of Consent
*
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Month
/
Day
Year
Date
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