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Student Intake Form
Answer a few questions about your student
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* Indicates required question
Student Name
*
Your answer
Student Email
*
Your answer
What school does your student attend?
Your answer
Parent Name(s)
*
Your answer
Parent Email
*
Your answer
Parent Phone number
*
Your answer
Student Phone number
For session auto-reminders or reaching them when there are problems with connecting via Zoom (i.e. audio isn't working)
Your answer
Address
Your answer
What Math level does your student need tutoring? Or ACT/SAT prep?
*
Example: Algebra 2 and/or ACT prep
Your answer
What is your current availability?
*
Ex. Anytime between 3p-8p Mon-Fri, except Tues/Thurs from 4-5:30p. This is to help make schedule changes, if necessary, when trying to accommodate everyone.
Your answer
What should I know about your student? Any diagnosis or suspected learning difficulties? Strengths and Weaknesses?
Your answer
Comments or Anything Else I Need to Know
Your answer
Cancelation Policy: A minimum of 24 hours is required to cancel/reschedule sessions without penalty. Calendly will email a reminder 24 hours before your session, and you can reschedule or cancel within Calendly. If less than 24 hours is given, I reserve the right to charge the full amount.
*
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I understand I will be charged if I cancel with less than 24 hours notice.
Refund Policy: I don't offer any refunds for prepaid sessions. but they can be used until the end of the school year for any math tutoring (or even ACT/SAT prep) or used by siblings. Sessions not used for more than 3 months or before the beginning of the next school year will be forfeited.
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I understand you don't offer refunds and that I must use my sessions within the current school year or lose them.
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