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Academic Coaching Intake Form
This form is confidential. These questions will help the Om Work Guru to understand how to assist you or your child with academics. If you would like to book a yoga or mindfulness coaching session send an email to theomworkguru@gmail.com


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Email *
What kind of academic coaching are you interested in? *
If you are looking for general homework help, what subjects do you or your child (referred to henceforth as 'the student') require assistance in? *
What is the student's age? *
If the student is in school what grade are they in? *
Does the student I will be assisting have any diagnoses that could affect their ability to learn? *
What is your biggest academic concern regarding the student? *
What are the student's academic strengths? *
What kind of hobbies or interests does the student have outside of academics? *
Is the student on any medication that could affect their ability to learn? *
Is there anything else I should know (students preferred pronouns, using goverment subsidies etc.)? *
Do you have access to a printer. *
What is your preferred contact method? *
Required
If you would like to be contacted by phone please provide a phone number, and the best day/time to call.
What is your name, so I know who to adress when I respond via email/phone call? *
How did you hear about the Om Work Guru? *
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