Tutoring Request Form
New and returning clients will need to submit a request to book packages for tutoring sessions at this time. We appreciate your business! (Please allow 24 hours to receive an email response to all requests during business hours. Weekend requests are not guaranteed a 24-hour response time.)
Your Full Name (Name of Parent or Guardian Filling Out this Form)
*
Mr.
Mrs.
Ms.
Miss
Prefix
First Name
Last Name
Your Child's Name (Last Name NOT Required)
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Phone Number
*
E-mail
example@example.com
What grade is your child currently in (OR for Summer Sessions going to)?
*
Please Select
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
Which service are you requesting?
*
Please Select
Tier 1 (Once a Week) - 4 Wks
Tier 2 (Twice a Week) - 4 Wks
Tier 1 (Once a Week) - 8 Wks
Tier 2 (Twice a Week) - 8 Wks
How would you like your sessions?
*
Please Select
In-Person
Virtual
Have you already booked a consultation and/or met with Ms. Mitchell about the tutoring services you want to book for?
*
Yes (This includes in-person, virtual, email, and phone call)
No (Please Return to our Website and Click 'Book Your Consultation')
Submit
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