Academic Year Individual Tutoring Request Form

Student First name

Student Last name

Parent/Guardian Name:

Parent/Guardian Email

Parent/Guardian Phone

How many 1-hour sessions are you seeking per week?

Intended tutoring start date (2026-2027 academic year tutoring begins the week of 9/14/26)

Month

Day

Year

Do you anticipate any changes to your student's schedule during the school year? (i.e. seasonal sports, travel, other commitments, etc)

Are there any specific dates that you anticipate your student will miss tutoring during the 2026-2027school year?

Are you seeking tutoring for the entire school year or a specific period of time? Please specify.

Student Availability (check all that apply)

Are you interested in any of the small group options for open math/science help?

Wednesdays 330-430pm

Thursdays 730-830pm

Sundays 2-4pm

What subject(s) is your student seeking tutoring for?

Anything other subjects you're seeking tutoring for? Please specify.

Anything helpful for me to know about your student (i.e. learning style, IEP/504 plan, strengths/weaknesses etc.)