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Tutoring Client Questionnaire
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* Indicates required question
Email
*
Your email
Name of student receiving tutoring (first and last name):
*
Your answer
Name of parent/guardian #1 (This person will be the main point of contact.):
*
Your answer
Phone number of parent/guardian #1:
*
Your answer
Email of parent/guardian #1:
*
Your answer
Name of parent/guardian #2 (optional):
Your answer
Phone number of parent/guardian #2 (optional):
Your answer
Email of parent/guardian #2 (optional):
Your answer
Preferred method of communication (select all that apply):
*
Text message
Phone Call
Email
Required
Student's grade level (If summertime, grade level your child will be entering :
*
Your answer
School student is attending:
*
Your answer
Student's math teacher:
*
Your answer
Math Teacher's email (if you know it):
Your answer
City student resides in:
*
Your answer
Are you interested in virtual/online tutoring or in person tutoring? (check all that apply)
*
In-person only (must be local to Lowndes County, GA or nearyby)
online/virtual only
I'm open to either option
Required
Are you interested in virtual/online tutoring or in person tutoring? (check all that apply)
*
In-person only (must be local to Lowndes County, GA or nearyby)
online/virtual only
I'm open to either option
Required
What times work best for private tutoring?
*
Mornings
Afternoons
Evenings
Required
What days work best for private tutoring? (Select all that apply.)
*
Monday
Tuesday
Wednesday
Thursday
Friday
I'm flexible during the summer as long as we get our sessions in each week.
Required
Please type any additional information you think I should know about your child:
*
Your answer
Reason for seeking math tutoring services:
*
Your answer
How did you find out about CMT Tutoring Services?
*
Your answer
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