Tutoring Intake Form
We're so glad you're here! Fill out the form below to get started and we'll be in touch shortly to match your student with the right support. Let's get to work! 📚✨
Parent/Guardian Information
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Preferred Contact Method
*
Phone
Text
Email
Student Information
Name
*
First Name
Last Name
Grade Level for the 26-27 School Year:
*
Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
What concerns do you have about your child’s academic progress?
*
Please place a copy of any recent assessment scores, MAP data, iReady data, report cards, or teacher notes.
Browse Files
Drag and drop files here
Choose a file
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Scheduling Preference
Preferred Day(s):
*
Monday
Tuesday
Wednesday
Thursday
Preferred frequency:
*
1 day per week
2 days per week
3 days per week
Not sure yet
Tutoring Format
*
In-person
Virtual
What date would you like to begin?
-
Month
-
Day
Year
Date
How did you hear about these services?
*
Referral
Social Media
School/Work
Other
Payment
Your payment holds your tutoring spot and will be applied to your first session.
Which tutoring option would you like to begin with?
*
Hourly (Pay-as-you-go) – $40/hr
Starter Pack (4 sessions – $150)
Growth Pack (8 sessions – $280)
Success Pack (12 sessions – $390)
I'd like to schedule a phone call prior to scheduling.
Sessions
*
prev
next
( X )
Hourly (Pay-as-you-go)
$40.00
$
40.00
Quantity
1
2
3
4
5
6
7
8
9
10
Starter Pack (4 sessions)
$150.00
$
150.00
Quantity
1
2
3
4
5
6
7
8
9
10
Growth Pack (8 sessions)
$280.00
$
280.00
Quantity
1
2
3
4
5
6
7
8
9
10
Growth Pack (12 sessions)
$390.00
$
390.00
Quantity
1
2
3
4
5
6
7
8
9
10
10min Consultation Call
Free
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Submit
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