Smarter Bees Educational Services Intake Form

Intake Form
Welcome to Smarter Bees Educational Services

Let’s get buzzing! Please complete this form to enroll in tutoring or schedule consultation services
What brings you to the Smarter Bees hive today?*

I’m signing my child up for tutoring servicesI’m seeking a parent/guardian consultationI'm signing up for adult education services
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.
City and ZIP Code*

S

CityState / Province

Postal / ZIP Code
Agreement to Receive Buzz-Worthy Updates!

I agree to receive text messages from Smarter Bees which may include appointment reminders, scheduling updates, service-related information, or follow-ups.
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.
Tutoring Information

Please complete one form per learner. The only exception is for our Buddy Bees Program, where two learners within one grade level and with similar goals may share a form. Otherwise, please submit a separate form for each learner. Thank you!
Learner Name*

First NameLast Name
Buddy Bee Learner if Applicable

First NameLast Name
Learning Stage*
Buddy Bee Learning Stage if applicable
Emergency Contact *
Frequency*
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.*

Yes, I give permssionNo, I do not give Permission
Learning and Engagement
Tutoring Subject Needs*

ReadingMathWritingPhonics/Phonemic AwarenessWilson Reading System® (WRS) 2nd Grade and up onlyIEP Goals
In-Person or Virtual Learning*

In-PersonVirtualUnsure
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.)*
Are there any allergies or medical needs we should be aware of?*
Are there any cultural or personal preferences we should consider?*
Consultation Information
Current services we offer*

FREE 15 minute Initial ConsultationIEP/504 Review and/or RevisionSpecial Education Program EvaluationAdvocacy and Representation at IEP/504 MeetingsParent/Guardian Education/CoachingCustomized Learning Plan DevelopmentHomeschooling Consultation
Preferred Consultation Methods*
Please briefly describe how we can help.*
How did you hear about us?*

Current ClientSchool PersonnelSelf-SearchInstagramFacebookCommunity EventLocal LibraryWilson Dyslexia Practitioner SearchOther
If you were referred by a current client or a member of your school’s personnel, please include their first and last name so we can thank them!
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Intake Form

Welcome to Smarter Bees Educational Services

Tutoring Information

Learning and Engagement

Consultation Information