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Virtual After School Tutoring Interest Form
Start Date: October 27, 2020
Wednesday 8:30am -4:30pm
Zoom Link:
https://esd123.zoom.us/j/89188852590?pwd=WVJmYks5cVBlMW43SWtKaDcyRXdRUT09
Contact us:
Annabell Gonzalez
509-222-6180
annabell.gonzalez@ksd.org
or
Margarita Alaman
malaman@esd123.org
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* Indicates required question
Student First Name Last Name
*
Your answer
Student ID
Your answer
Email address (this will be the email that students get the zoom link)
*
Your answer
Who referred you? (example: a counselor, teacher, yourself, etc...)
*
Your answer
Parent or Guardian First Name Last Name
*
Your answer
Parent or guardian email
Your answer
Parent or guardian phone number
*
Your answer
School
*
Choose
Chinook
Desert Hills
Highlands
Horse Heaven Hills
Park
Kamiakin High
Kennewick High
Southridge
Legacy
Phoenix
Online Academy
Other
Grade
*
Choose
6th
7th
8th
9th
10th
11th
12th
Other...
Subject you need help with (you can check more than one box)
*
Geometry
Alegebra
Language Support
Language Arts/History
Technical Support
Math
Science
Other:
Required
Is there anything else we can help you with?
Your answer
If we are able to offer other days and times for tutoring, is there a better day and time that would work for you?
Your answer
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