Tutee Intake Form
Complete the form below outlining your student's needs. ONE FORM PER STUDENT.
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Email *
STUDENT'S INFORMATION
Grade as of September 2023 *
In which subject(s) does your students need tutoring? *
Required
Student's First Name *
Student's Last Name *
Student's Mobile Number (to be used to communicate with parent and student AFTER being matched with a tutor)
Student's Email (will only be used AFTER student is matched with a tutor) *
Gender *
Male
Female
Prefer not to say
Select One
Does your child have a learning disability? (This will help us and the tutor address your student's needs appropriately) *
Required
My students struggles with the following (slide to the right): *
Peer Relationships
Conflict Resolution
Bullying
Social Isolation
Self-regulation
Empathy
Anxiety
Depression
Off-task, task persistence
Noncompliance
Verbal/physical aggression
Avoidance/escape
NONE OF THE ABOVE
Social/Emotional/Behavioral
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