Gateway Community Services Maine- Tutee Referral Form
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Name *
What are your pronouns? 
Who referred you to GCSM?
Email address *
Phone Number *
Preferred way to contact you *
If you use WhatsApp, please check "other" and enter your WhatsApp number
What grade are you in? *
What is your birthdate?
DD
.
 
MM
.
 
RRRR
What school do you attend?
Subjects you would like support in
If you have a more specific subject in mind, please type it in the "other" field
What days and times would you be available for tutoring?
Scroll to the right for more times
9am
10am
11am
12pm
1pm
2pm
3pm
4pm
5pm
6pm
7pm
8pm
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Which tutoring locations would you be interested in? *
Povinné
Would you be comfortable doing tutoring in English? *
If not, what language would you prefer?
Country of origin
Where are you from?
Is there anything else you would like us to know about?
Are you over 18 years old? *
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