Tutoring Intake Form
Thank you for choosing Structured Tutoring through Franklin the Helper® Children’s Books, LLC. This form allows us to gather important information about your student and confirm enrollment details. Please complete all sections carefully to ensure a smooth start to instruction.
Student Information
Student Full Name
*
First Name
Last Name
Which subject(s) do you need tutoring in?
*
Reading
Writing
Both
What is your current grade or academic level?
*
Please Select
Elementary School
Middle School
High School
College/University
Other
What is the name of your school?
Parent/Guardian Information & Questions
Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
In what part of DFW do you live?
This question is to help determine the tutoring fee.
Emergency contact name and phone number
*
Is your child in agreement with coming to tutoring?
*
Yes
No
Somewhat
What are your main goals for tutoring?
*
Please be specific
Preferred days and times for tutoring sessions
*
Additional comments or special considerations
Signature
*
Continue
Continue
Should be Empty: