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's Full Name
*
First Name
Last Name
What is your student's current grade or academic level?
*
Please Select
Elementary School
Middle School
High School
College/University
Other
What is the name of your student's 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.
Emergency contact name and phone number
*
In which subject does your student need tutoring?
*
Reading
Writing
Math
Comprehension
Vocabulary building
In what part of DFW do you live?
This question is to help determine travel distance.
Is your student in agreement with coming to tutoring?
*
Yes
No
Somewhat
Has your student been diagnosed with a learning disability, learning difference, developmental disability, or other condition that may affect learning?
*
Yes
No
Currently being evaluated
Prefer not to answer
Does your student currently have an IEP, 504 Plan, accommodation plan, or other educational support plan?
*
Yes
No
Prefer not to answer
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: