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VICTORY Tutorial Student Registration Form
Complete the application to enroll your child in the VICTORY Tutorial Program.
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* Indicates required question
Email
*
Your email
Student Name
*
Your answer
School
*
Your answer
Grade
Your answer
ID number (Austin ISD students only)
Your answer
Gender mark one
*
Choose
F
M
Prefer not to disclose
Birth date
*
MM
/
DD
/
YYYY
Ethnicity mark one
*
Choose
Hispanic
Not Hispanic
Prefer not to disclose
Race
*
Choose
Asian
Black or African American
Native Hawaiian or Pacific Islander
White
Multiple race
Prefer not to disclose
The student receives free or reduced price lunch:
*
Yes
No
Prefer not to disclose
Required
Zip code
*
Your answer
Subject student needs the most help in:
*
MTH
RDG/ELA
SCI
SS
Required
Preferred tutoring day
*
M
Tu
W
Th
Fr
Required
Tutoring time
*
8 am
9 am
10 am
11 am
12 pm
1 pm
2 pm
3 pm
4 pm
5 pm
Required
Will your child be learning from school or remotely at home?
*
Choose
School
Home
Do you have have access to a computer and Internet at home?
*
Choose
Computer only
Internet only
Both
None
Parent/Guardian Consent: Do you give consent for your child to participate in the VICTORY Tutorial Program?
*
Choose
yes
no
Parent/ Guardian Consent: Do you give The VICTORY Tutorial Program consent to access your child's educational/school records for the current school year?
*
Choose
yes
no
Parent name
*
Your answer
Phone number
*
Your answer
Date of consent
*
MM
/
DD
/
YYYY
AISD/ VICTORY Representative who facilitated student registration:
Your answer
Is there any additional information you would like to share regarding your student?
Your answer
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