Student Tutoring Intake FormStudent & Parent/Caregiver Contact Information Student Name * First Name Last Name Student Email * Student Phone * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country What should we call you? * Parent/Caregiver Name * First Name Last Name Parent/Caregiver Relationship to Student * Parent/Caregiver Phone * (###) ### #### Parent/Caregiver Email * What is the best way to contact you (parent/caregiver)? * Phone Email School Name * Grade Level Fall 2020 * Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12 What subject would you like tutoring services for? * Math Science Writing Reading History Orchestra Band Other What level are you requesting tutoring? * Academic Honors/Advanced What class in this subject did you take last year? * What was your grade in last year's class? * What do you consider your academic strengths? * What do you consider your academic weaknesses? * How do you learn best? * Group Individual What type of learner are you? * Auditory Visual Tactile What do you plan to get out of the tutoring sessions? * What is your specific academic goal in the class for which you will be receiving tutoring? Please be as specific as possible. * Is there any additional information you feel your tutor should know? * Thank you! We received your submission and will get back to you shortly.
