CREHS Inc Math Tutoring Registration Form
CURRENT MATH OFFERINGS
Online Math Tutoring for:
Grades 11 and 12
College and University Years 1-4
Postgraduate
Tutoring (1-hour Class)

REGISTRATION NOW OPEN
●  Fill out the Google Form Below.

FEATURES
●   Highly qualified (College & University Professors) and experienced teachers
●   Online Class size: 5—10 students (small teacher-to-student ratio)
●   Personalized/customized support for students
●   Extra help available
●   Student-centered learning strategies

PAYMENT OPTIONS:
●   By email transfer:  crehsincpayments@gmail.com
●   By e-commerce (www.crehsinc.com)


Click on the FILL OUT FORM below. This should take no more than 8-10 minutes.

*Contact: Dr. Leroy Clarke, LearnOnline@crehsinc.com; 905-451-5979 (Office) https://www.crehsinc.com
A. Student Information
Remedial Math Tutoring: Grade 11 to Postgraduate University
A1. First Name: *
A2. Last Name: *
A3. Other Names (optional):
A4. Gender:
A5. Date of Birth
MM
/
DD
/
YYYY
A6. Email *
A7. Mobile Phone
A8. Home Phone:
A9. Home Address
Street Number and Name:
Apartment or Suite Number:
City/Town:
Province/Territory/State:
Country:
A10. Name of High School/College/University
Name of your High School, College or University:
B. Parent/Guardian Information (complete this section if you are under 18 years old and/or in High School):
B1. Parent/Guardian First Name:
B2. Parent/Guardian Last Name:
B3. Relationship to Student (select the circle which applies to you):
Yes
Parent
Guardian
Clear selection
B4. Email (Parent/Guardian):
B5. Phone Number (Parent/Guardian):
B6. Mailing Address of Parent/Guardian (fill out only if different from student address):
Street Number and Name:
Apartment or Suite Number:
City/Town:
Province/Territory/State:
Country:
C. Tutoring Requirements
Please provide the detailed subject(s) information in which the student requires tutoring.
C1. Are you currently enrolled in high school (select the circle which applies to you)? *
C2. Are you currently enrolled in a college or university program (select the circle which applies to you)? *
C3. What is the name of the college/university program that you are currently enrolled in (eg., First Year BSc Engineering)?
C4. What is the Name of your current Math Course (eg., Grade 12 Advanced Functions)?
C5. What is the Course Code of your current Math Course (eg., MHF4U)?
C6. Is your Current Math Course Full-Year or Semester?
Clear selection
C7. If you require tutoring for specific topics, list the topics below:
C8. List the name of your textbook and the Publisher as well as any further information that will help us to serve your tutoring needs (eg., Advanced Functions 12, McGraw-Hill Ryerson):
D. Scheduling
Please check off all the possible days of the week when the student would be available for tutoring. Beside each selection, indicate more specifically what time(s) of day would be most optimal.

What days and times are most convenient for your tutoring sessions? (select the circles which apply to you) *
8:00 AM
9:00 AM
10:00 AM
11:00 AM
12:00 Noon
1:00 PM
2:00 PM
3:00 PM
4:00 PM
5:00 PM
6:00 PM
7:00 PM
8:00 PM
9:00 PM
10:00 PM
N/A
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
E. Additional Information: Your Career/Occupational Objectives
Indicate the professional field or job position you would like to enter after completing your current program.
What professional field or job would you like to enter after completing your studies?
F. I attest that all responses are true and accurate: *
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