TMT Intake Form

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TMT Intake Form

Thanks for choosing The Massapequa Tutor for your educational needs! Please take a minute to fill out this form so we can learn how TMT can best help your son/daughter.

Parent full name *

Student full name *

Email *

Cell phone number *

Preferred Method of Contact

Text

Call

No preference

Clear selection

Hometown *

How did you find out about TMT? *

Facebook: via The Massapequa Tutor's page (facebook.com/themassapequatutor)

Facebook: via Dan Hepworth or a tutoring Facebook group

Instagram

Our website

Google/the internet

Referral

Required

If you were referred to us, who referred you? A specific name is best so we can thank them :)

What school does your child currently attend? *

What grade is your child currently in? *

Which of our services are you interested in utilizing? (select all that apply) *

One-on-one subject/class tutoring

One-on-one ACT/SAT Prep

Group classes/exam review

Required

Which subject(s) would you like help with? *

What is their schedule like? Any major conflicts? What days/times work best? *

Which meeting locations work best? (select all that apply) *

House

Local library

Cafe (i.e., Starbucks, Panera Bread, etc.)

Virtual (Facetime/Skype) -- with COVID-19, we're strongly encouraging virtual tutoring. We do a limited amount of in-person instruction following guidelines. We have a guarantee that if you are not DELIGHTED with your virtual session, we'll issue a full refund.

"Meet in the middle" (flexible with locations, such as in the event your child can drive)

Required

Important notice (November 16, 2020)

Due to a recent rise in coronavirus cases, The Massapequa Tutor will suspend all in-person tutoring sessions beginning November 21, 2020. The last day for in-person tutoring sessions will be November 20, 2020. All tutoring sessions will be held virtually until further notice. This decision was made for the safety of our team, our students, and the families of each. Thank you for your understanding.

If you are interested in having us work at your home, what is your address? Please include the town and ZIP code.

How has your son/daughter performed historically academically with respect to the area they need help in? Any specific strengths/weaknesses? For tutoring, it is best to describe your child's performance in the classes they need help in; For the SAT/ACT, it is best to list any previous scores on tests taken *

Is there anything else we should know about your son/daughter? Common items people list here are allergies, testing accommodations, ADD/ADHD, etc. Information given here is always kept private. *

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