Private Tutorial Sessions

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Email *

General Tutoring

• Extra support and accountability for virtual work/assignments/homework
• Additional time and support for concepts taught in the classroom
• Higher level of support and accountability for learning
• An intentional approach with multi-sensory techniques
• Remedial instruction for gap areas in learning (tutoring goals to be established)

Date: *

YYYY

Tutoring Start Date:

YYYY

Student Name: *

Student Age: *

Student Birthday:

Student Grade: *

School: *

School District: *

Parent Name: *

Parent Email: *

Home Phone:

Mobile Phone: *

Student may be released to:

Does your child have an IEP, 504, and/or RTI?

Yes

Unsure

Clear selection

What subject(s) areas does your child need tutoring ? *

Please indicate any specific areas of concerns that need to be address in tutoring.

Please list day(s) and time(s) preferences.

Are you interested in having tutoring for the entire school year? *

Yes

If not, how many lessons would you like for your child?

Do you plan to continue services in the summer? (next grade-level preview/enrichment)

Yes

Clear selection

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