Name *

First Name

Last Name

Phone (Optional)

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Which kind of tutoring do you think works best for your child?

Choose all that apply. You WILL NOT be scheduled for any types of sessions that you do not prefer for your child.

In-Person 1-on-1

Virtual 1-on-1

Does your child have an IEP, clinically diagnosed learning disability, or other condition that presents challenges to his or her academic progress?

Check all that apply. We see potential for great success in ALL children. Your answer WILL NOT disqualify your child from our services.

IEP

Learning Disability

Other Condition

Which of the following subjects or developmental areas are the most difficult for your child?

Check all that apply.

Numbers / Math

Phonics / Reading

Writing

Speech (ie. willingness to speak, pronunciation, vocabulary or volume)

Conversation

Reading Comprehension

Confidence in the Classroom (ie. asking or answering questions and working in groups)

Tests & Quizzes (ie. anxiety or failure to recall what was studied)

Obedience to Teachers

Obedience to Parents

Self-Esteem

Social Connections with Peers

For what time of day are you interested in scheduling your child's session?

Choose one.

MORNINGS - 8:30 a.m. to 12 noon

AFTERNOONS - 12 :30 p.m. to 4 p.m.

EVENINGS - 4:30 p.m. to 8:00 p.m.