The Kid Connection
Tutoring Request Form
Student's Name
First Name
Last Name
Parent Name
First Name
Last Name
Parent's Phone Number
Parent's Email
example@example.com
Type of Tutoring
Subject Specific Tutoring
Dyslexia Tutoring
SAT/ACT Prep
Dyslexia Screening
Summer Subject Specific Tutoring
Summer Dyslexia Tutoring
Select all that apply for your child
Grade
Please Select
1
2
4
5
6
7
8
9
10
11
12
Please describe your child's current needs
Please upload a copy of your child's IEP or FIE if they have one.
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