Summer Tutoring & Exam Prep Intake Form

Summer Tutoring & Exam Prep Intake Form

The Virtual Tutoring Program offers personalized academic support to help students succeed. We provide targeted tutoring for exam preparation during specified dates, as well as 1:1 support for summer school courses, key concept review, and proctoring services. This pre-registration form helps us identify each student’s needs and goals. Once submitted, our Coordinator will follow up to confirm the support plan and finalize registration and payment details.
Section A: Student Information
Are you a Sr. MAP student?
Student full name

First NameLast Name
Date of birth

MonthDayYear
Date
Grade level
School name
Student email
example@example.com
Section B: Parent/Guardian Information
Parent/guardian full name

First NameLast Name
Relationship to student
Parent/guardian email address
example@example.com
Parent/guardian phone number
Please enter a valid phone number.Format: (000) 000-0000.
Preferred method of communication

Other
Section C: Service Requested
Please select the service(s) you are requesting:

Other
Section D: Academic Support Needs
Subject(s) requiring support

Other
Specific course code(s) (if applicable)
Brief description of challenges or goals
Section E: Availability
What days are you available in the week?
What times in the day are you generally available?
Section F: Additional Information
Does the student require any learning accommodations staff should be aware of?
Is there anything else you would like us to know?
Section G: Consent
I consent to be contacted regarding services
Parent/guardian signature
Should be Empty:

Summer Tutoring & Exam Prep Intake Form

Section A: Student Information

Section B: Parent/Guardian Information

Section C: Service Requested

Section D: Academic Support Needs

Section E: Availability

Section F: Additional Information

Section G: Consent