Student Intake Form

Student Intake Form

Please fill out the form below.
Thank you so much for choosing Mrs. Holman's Classroom, LLC, (aka me!) for tutoring!

Please fill out the form below. This will allow me to see if we are a good fit. If I think we are a good fit, you will recieve a separate invoice for payment prior to our first session, as well as log-in details to Canvas and any follow-up questions I may have.
Basic Details
Parent Name*

First NameLast Name
Student's Name*

First NameLast Name
2nd Student's Name (if applicable)

First NameLast Name
Parent's Phone Number*
Parent's Email*
example@example.com
Parent Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
All students will have access to their own "course" in Canvas. Students need an email address to log in to their course.

Canvas will house session notes, zoom links, homework assignments if requested, and if the students homework they want to go over during our session, there will be a spot for them to upload that prior to our session also.
Student Email (used to create Canvas log-in.)*
example@example.com
2nd Student Email (used to create Canvas log-in.) (if applicable)
example@example.com
Tutoring Details

Please select your tutoring package, along with your student's grade, type of math and type of schooling. Then answer the question.
All prices are for 30 minute sessions and apply to both online and in-home tutoring:
- One-Time: $60
- Once Weekly ((billed monthly): $180
- Something else already arranged
Type of Tutoring Package*
Grade*
Please choose your student's current grade.
Type of Math*
Please choose your students math level (does not have to be the same as their grade).
If you chose other, please explain. Otherwise, put N/A.
Type of Schooling*
Please choose what type of school your child had last year. If different from this year, please explain in the next question.
What are your goals for tutoring? What would you like your student to accomplish or why are you hiring a tutor? If homeschooling, what curriculum are you using?*
Are you using EFA funds?

YesNo
Signing this is the same as signing the tutoring contract: *

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Second Tutor Session (if you chose twice weekly)
Should be Empty:

Student Intake Form

Basic Details

Tutoring Details