MathValues, Inc. Tutoring Questionnaire
MathValues, Inc. dedicates itself to providing the optimal tutoring experience. We ask that you take this quick survey to help with scheduling our Spring semester FREE math tutoring sessions. Questions with a black * provide data pertinent to grant opportunities for MathValues, Inc. Thank you again for your interest in MathValues, Inc.
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What is your name? (First Name, Last Name) *
What is your contact information? (cell phone number & email address) *
What is your child's name? (First Name, Last Name) *
Are you or your family receiving any government assistance in the form of SNAP, TEFAP, TANF, WIC, or HUD?* (Answers to this question are kept confidential and help with scheduling order. Children who are in most need for our free services will be scheduled as a top priority.) *
Does your child have a IEP (Special Education) or 504 Plan? If so, can you provide us with the information about the plan? (Answers to this question are kept confidential and help with the tutor matching process. Children who are in most need for our free services will be scheduled as a top priority.) *
What is your child's gender?*
Clear selection
What is your child's racial or ethnic identification?*
Clear selection
How did you hear about us? *
What grade is your child in? *
Have you already reviewed and signed the MathValues' Parent Agreement Form? You DO NOT need to fill out a new Parent Agreement form if you are returning to MathValues from a previous semester. *
What subject does your child need help with? *
Required
What specific Mathematical topic does your child need assistance with? (ex: adding fractions, functions, volume, slope, etc.) *
What is your child looking to gain from the tutoring session? *
Required
On a scale of 1 - 5, how does your child feel about Math? *
On a scale of 1 - 5, how confident is your child with Math? *
Please list your child's availability for the Fall semester. (Days, Times, and Time Zone). *
If your child is selected, are you willing to complete a follow up questionnaire at the end of the semester? *
Is there any additional information you would like to share with us that can assist us in tutoring your child? *
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