Student Information

Parent / Responsible Party

First name

Last name

Email

Cell Phone

Student 1 Name*

Student 1 Grade Level*

S1 Academic Subject Focus*

S1 Academic Concern*

Student 2 Name

Student 2 Grade Level

S2 Academic Subject Focus

S2 Academic Concern

Choose Tutoring session type*

private

group

Student Weekly Schedule Options* Please choose at least 3 optional days of availability.*

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Time Options* Please select an available time frame that works best for your schedule. 🍎ONLY TIME AVAILABLE FOR SATURDAYS*

🍎 9am -11am

1pm - 4pm

4pm - 6pm

6pm - 8pm

Friday

Saturday

Academic documentation: You may upload any testing or documentation needed to place your student in the appropriate group.

Include any additional comments below.

Call or Text: 972.914.9295 F 972.546.1798 contact@myacademiatutor.com

bottom of page