Piñon Tutoring Initial Questionnaire
Please complete the following form and submit it at least 48 hours before your first tutoring session.  People under 18 years of age must have their parents or guardians complete this form.  Parents, you are welcome to ask your child for their input when completing this form.  If you are a parent seeking assistance with homeschooling, please write N/A in response to any questions that do not apply to you.
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Parent/Guardian's (Client) Name: *
Parent/Guardian's (Client) Email: *
Parent/Guardian's (Client) Telephone: *
Parent/Guardian's (Client) Address: *
Student's Name: *
Student's/Parent's/Guardian's Pronouns (we are a gender affirming business and respect all genders and gender expressions)
Clear selection
Student's Age: *
Student's Grade (if summer, grade student will enter in fall): *
In-person tutoring at your home or online tutoring? *
How many sessions would you like per week?
Clear selection
How long would you like each session to be?
Clear selection
Please describe your weekly availability.  For example, "We are available for tutoring sessions on Tuesdays and Thursdays between 4:00 PM and 7:00 PM, Wednesdays between 3:30 PM and 6:00 PM, and Saturday mornings." *
The service(s) the student or parent requires are: *
Required
The student's area(s) of strength are: *
Required
The student's area(s) for improvement are: *
Required
If possible, please provide more details about what specifically needs to improve.  For example, if you selected "Math" above, what specific math concepts are areas of struggle?
What feedback has the student's teacher provided regarding what and how to improve? *
Does the student have any learning differences?  If so, please describe. *
What are the student's interests and hobbies? *
What are your/the student's goals in receiving tutoring? *
Do you have any pets?  Please describe.  (We love them!  We just have a couple of tutors who are highly allergic to certain animals, so we appreciate your honesty).
Is there any other information that you feel the tutor should know?
I agree that I am contracting Piñon Tutoring LLC by Seth A. Stambaugh to provide tutoring services for a student in the subject area(s) listed on this form for a period of time to be determined by the necessity of the student, by the tutor, or by the client.  I have read and agree to Piñon Tutoring's Privacy Policy and Terms and Conditions as listed at: https://www.pinontutoring.com/privacy-policy and https://www.pinontutoring.com/terms-and-conditions.  Piñon Tutoring will not be able to offer tutoring services if you select "No." *
Today's Date: *
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Thank you!
Your tutor will review your questionnaire before the first tutoring session to choose appropriate assessments.  
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