Amy Seeley- 1:1 Student Inquiry Form

Scheduling with Amy Seeley

After completing, we will be in touch to suggest a testing timeline and prep plan to maximize student performance. For more information about Amy Seeley: https://seeleytestpros.com/meet-amy/
Student Name*

First NameLast Name
Location*

Greater CincinnatiGreater ClevelandOther
What test is your student interested in prepping for?

ISEE (private HS entrance)HSPT (private HS entrance)PSAT/National Merit ScholarshipACTSATGRE
Gender*

FemaleMalePrefer not to answer
High School Graduation Year*

20262027202820292030High School GraduateOther
Parent/Guardian Name*

First NameLast Name
Parent E-mail*
So that we can get back to you
Parent Cell Phone Number*

Area CodePhone Number
Which school does your student attend?*
What is his/her approximate GPA? (Prefer unweighted)*

Over 4.03.8 - 4.03.5 - 3.793.3 - 3.493.0 - 3.292.8 - 2.992.5 - 2.79Below 2.5
Do you have a goal score? If so, what?
What math course is the student taking this year?*
Student's Current English/Reading Course:*
Student's Current Social Studies Course:*
Student's Current Science Course:*
Has your student done any formal test prep? If so, what program?
Does this student take any advanced, honors, AP, or IB courses:*

AdvancedHonorsAdvanced Placement (AP)International Baccalaureate (IB)Duel EnrollmentNone
What subjects tend to be areas of strength for this student?*

English (grammar/writing skills)Reading (reading comprehension skills)ScienceMathSocial Studies
What subjects tend to be areas of concern for this student?*

English (grammar/writing skills)Reading (reading comprehension skills)ScienceMathSocial Studies
Has this student taken an official test?*
If you answered yes to the previous question, what were the student's scores (please list specific individual section scores, if possible)?*
Does your student tend to run out of time on standardized tests?*

YesNo
Has your student been granted extended time?*

YesNo
IF your child has been granted extended time, is he or she STILL running out of time even with extended testing time?

YesNo
Does your student have test anxiety?*

YesNo
IF yes, is your child medically treated for anxiety with medication or counseling?*

YesNo
What style of tutoring would this student benefit most from?*

"12th Grade AP Teacher:" Holds his/her students to a high standard and expects the most. Enforces responsibility and accountability in sessions. Expects maturity and diligence from students, and isn’t afraid to call a student out when they start to fall below potential."10th Grade English Teacher:" Sees themselves in his/her students as a younger, more approachable tutor. Tries to really connect with the students so that they see themselves in him/her. Fairly laidback and non-confrontational to avoid losing connection."8th Grade Science Teacher:" Serious and committed to making sure his/her students are ready for the next level of schooling. Encourages maturity and helps the student understand how much they need to be responsible for their future. Emphasizes learning the basics in a straightforward, no-messing-around manner."Kindergarten Teacher:" Recognizes that his/her students are brand new to this environment and approaches students from a place of comfort and support. Leans on positive reinforcement and lets mistakes slide more easily to avoid hurt feelings.
What is your expectation for the student's ability to complete homework each week:*

5 hours a week: Dedicated to tutoring sessions, homework, and studying necessary materials every couple of days3 hours a week: Dedicated to tutoring sessions, homework, and reviewing materials once a week2 hours a week: Dedicated to tutoring sessions and homework1 hour a week: Dedicated only to the tutoring session - no time outside to complete additional work or study
What high schools, colleges, or universities is the student currently interested in? (if undecided, list N/A)*
Expected Test Date(s) If Applicable (if undecided, list N/A)*
Has this student been referred to LEAP or Seeley Test Pros by a specific individual? If so, please list their name(s):*
Additional helpful comments.
After school activities & commitments.
How did you hear about us?
What location(s) could this student meet?*

Digital platform on ZoomRocky River @ Seeley Test Pros 20525 Center Ridge Road, Suite #611
Which preparation package are you requesting?*

One hour (one on one) - $200.00/ payable at each session on an hourly basisAdditional recorded ACT seminar package - $249.00Additional recorded ISEE seminar package - $149.00Additional recorded HSPT seminar package - $149.00
Seeley Test Pros/ LEAP will attempt to accommodate scheduling changes, but only with a minimum of 24-hours notice prior to the scheduled tutoring appointment. Notice must be provided by phone, directly to the instructor. If email and/or text communications of the cancellation are provided, such are only effective upon the receipt and responsive confirmation by the instructor. Cancellations with less than 24-hours advance notice will result in a charge of the full amount of the scheduled time. In the case of inclement weather (e.g., snowstorms) and emergencies, we will make a determination on fee waivers for late cancellations due to emergencies.*

Checking this box is acknowledgement that you have read and agreed to this cancellation policy.
This form completed by:*

ParentStudentOther
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Scheduling with Amy Seeley