We are a Seed of Support to Help Students Blossom
Our Support Leads to Success in LITERACY + READING + WRITING + COMMUNICATION
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
-
Area Code
Phone Number
Are you the student, parent, guardian, or representative?
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Please Select
I am the student
I am the parent
I am a representative for the student
I am the guardian or relative for the student
If you are not the student, what is the student's full name?
What level of education is the student in?
*
Elementary
Junior High School
High School
College
Post Graduate
Trade
City Employee continuing education
What is the student's main goal for tutoring?
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Improve grades
Test preparation
Homework help
Build overall confidence
Learn English as a New Language
Personal Advancement or Knowledge enrichment
Pass a state exam required for career advancement
Other
Where do you prefer tutoring? (Check all that apply)
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Remote (Computer, tablet, or phone)
In-person (home or library)
At school
What time zone is the student in
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Central
Pacific
Eastern
Alaska
Hawaii
Mountain standard
Other
Does the student have an individualized learning plan (IEP)
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Yes
No
In the evaluation process to get an IEP
What is the student's preferred learning style? (Check all that apply)
*
Audio (lecture, recorder, audiobooks)
Visual (videos, presentations, photos, etc)
Kinesthetic (hands on activities and real world experiences)
Unsure but willing to be assessed
What time is preferred for tutoring? (Check all that apply)
*
Morning (9:00am to 11:00am)
Afternoon (12:00pm to 4:00pm)
Evening (5:00pm to 10:00pm)
What days will the student tutor? (Check all that apply)
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Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
When can the student begin tutoring sessions?
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Immediately (within 24-48 hours)
As soon as possible (within 3-5 days)
Next month (within 30 days)
Eventually (within 2-3 months)
Unsure (within 6 months)
Other
Literacy Rose Growth specializes in the listed skills. What skill area does the student want to focus on most?
Writing conventions and confidence
Reading Comprehension and analysis
Communication and public speaking
English language proficiency
Explain the subject area or skill that the student is struggling with
Is there anything else that we should know to best support student? Please explain important information about the student that is relevant to their learning environment
What form of payment do you prefer?
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Credit/Debit
Zelle
Cashapp
Paypal
Please type your name and email below to confirm
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