2021-22 Tutor Request Form
Please fill out ONE SURVEY PER STUDENT. We tutor every age, grade, and subject, from preschool to advanced high school courses. We also help with motivation, college applications, SAT and ACT. Email josh_wolters@hotmail.com with any questions.
We will try our best to match your child as quickly as possible, but it may take a few weeks.
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Student's Full Name (first and last) *
What grade is the student in? *
What does the student need help with? (check all that apply) *
Required
If you chose "specific subject(s)", please state the subject(s)
The following are our tutoring time slots. Select all times that your child can be tutored AND if they want to be tutored once or twice a week. *
Required
If the student is NOT fluent in English, what language do they speak best?
Student's gender *
What school does the student attend? *
Name of Parent (first and last) *
Parent Email *
Parent Phone Number *
Student Email (optional)
The following questions help us assess our program's impact. Please complete as many as you can. Thank you!
What best describes your child? (check all that apply) *
Required
Do you identify as low-income?
Clear selection
What percent of homework is you child currently completing?
Clear selection
FOR MIDDLE/HIGH SCHOOL STUDENTS ONLY: What is your child's current grade in Math class? (Ex: B+)
FOR MIDDLE/HIGH SCHOOL STUDENTS ONLY: What is your child's current grade in Science class? (Ex: B+)
FOR MIDDLE/HIGH SCHOOL STUDENTS ONLY: What is your child's current grade in English class? (Ex: B+)
How many subjects/classes is your child failing right now?
Clear selection
On a scale of 1 to 5, how confident is your child in their learning?
Not confident at all
Very confident
Clear selection
On a scale of 1 to 5, how motivated is your child to learn?
not motivated at all
Very motivated
Clear selection
Any questions or notes?
Submit
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