Smarter Bees Intake Form

What brings you to the Smarter Bees hive today?

Does your family participate in a state scholarship, ESA, or education funding program?

Parent/Guardian/Adult Name

First NameLast Name

Parent/Guardian/Adult Email Address

example@example.com

Parent/Guardian/Adult Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

City and ZIP Code

S

CityState / Province

Postal / ZIP Code

Agreement to Receive Buzz-Worthy Updates!

SMS Communication & Privacy Notice
By checking the box above, you consent to receive SMS (text message) communications from Smarter Bees, LLC regarding appointment reminders, scheduling updates, service-related information, or follow-ups. Message frequency varies. Message and data rates may apply. Your mobile number and message content will remain confidential and will never be shared or sold to third parties. You may opt out at any time by contacting Smarter Bees, LLC in writing.

Learner Name

First NameLast Name

Learner Age

If Other Please Specify

Learning Stage

If Other Please Specify

Tutoring Needs

In-Person or Virtual Learning

Frequency in which you would like to receive services

What motivates you or your learner (s)? (For parents/guardians, please answer based on what motivates your child(ren).)

What do you or your learner(s) dislike or find challenging when it comes to learning? (If you're completing this for your child(ren), please answer based on what you've observed they struggle with.)

May we have your permission to use photos, learner work, or testimonials for educational or promotional purposes (e.g., website, flyers, or social media)? This information will not be used for any other purposes and will never be shared without your permission.

Emergency Contact Name/Number/Relationship

Are there any allergies or medical needs we should be aware of?

Are there any cultural or personal preferences we should consider?

If you were referred by a current client please include their first and last name so we can thank them!

Which program does your family currently participate in?

If Other, please specify

Are you an approved participant for the selected funding administrator or platform?

Do you know if Smarter Bees needs separate provider approval or registration for this program? If yes, please share a link or contact information

Is the available account balance sufficient for services, frequency, and duration you prefer?

Optional: upload award or approval documentation, if you'd like us to have it on file

Current services we offer

Preferred Consultation Methods

Please briefly describe how we can help.

How did you hear about us?

Would you like your learner to participate in a paid 30 minute introductory session?

Would you like a free 15 minute consultation?

Smarter Bees Intake Form

Welcome to Smarter Bees Educational Services

Parent Contact

Learner Information

State Funding Families

Consultation Information

Introductory Services