Math Plus Tutors

Application Form 2017- 2018

Student Information

Name:

Grade Level:

School:

Area of Interest: Please check the applicable program

High School

High School Prep (Gr 7-8)

College/University

Special-needs (Gr 1-12)

Math Plus Junior

STEM Adventure Club

STEPS Day-Program

STEPS One-on-One

Art Class

Exam Prep

SAT

GRE

Subject of Interest:

Math

Science

English

French

Engineering

Statistics

Calculus

Physics

Chemistry

Biology

Anatomy

Physiology

Other; please specify:

Contact Information

Parent Name:

Tel (home)

Mobile

E-mail address

Guardian Name

Tel (home)

Mobile

E-mail address

For Students with Special-needs only:

Does your child have a special-need?

Yes; please specify

No

Does your child have a formal diagnosis?

Yes; please specify

No

Does your child have an IEP?  

Yes; please attach a copy of IEP

No

Anything we need to know about your child?