BrainBuzzed Tutoring Intake Form
Please complete the form below as it pertains to your tutoring/enrichment needs.
Service Needed?
Please Select
In Person Small Group Tutoring
After School Enrichment
Event Enrichment
Name
First Name
Last Name
Position
Email
example@example.com
Contact Number
District/Organization/Event
School/Event
School/Event Address
Academic Subjects (Small Group Tutoring or 1 on 1 services only)
Reading
Math
Science
STAAR Prep Strategies
Other
Enrichment Focus (Enrichment Only)
STEAM (Science, Technology, Engineering, Arts, Math)
Financial Literacy/Entrepreneurship
SEL (Social Emotional Learning
Sports Adventures
Board Game Adventures
Digital Adventures (Access to computer lab is necessary)
Boys & Girls Mentoring
Drone Adventures
Other
Grade Levels For Services
Kdg
1st
2nd
3rd
4th
5th
6th
7th
8th
9th-12th
Days of week of services
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday (Saturday School/Event Only),
How would you like sessions structured (per group)?
30 min
45 min
1 hr
Other
Please share how many tutors per subject are needed. (i.e. 2 for reading 1 for math) (Tutoring Only)(Billing will be done per instructional staff per hour)
Start/End Time of Session (Window for sessions services)
Start Date/End Date
If known, how many sessions total, will be required for your services? (Multiple sessions bookings)
If resources will be provided, please list them below. (Tutoring Only)
Will basic materials be provided? (Pencils, white boards, markers) (Tutoring Only)
Additional support requests needed? (i.e. SPED, Language, etc.)
Please share any additional details pertaining to your service request.
Please share any questions that you have for us?
Submit
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