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Student Information
Parent / Responsible Party
First name
Last name
Email
Cell Phone
About Student
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
Scheduling Options
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
Additional Notes
Academic documentation: You may upload any testing or documentation needed to place your student in the appropriate group.
Upload File
Include any additional comments below.
Submit
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