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                  Educating Young Minds, Inc. EYM                                            Tutoring and Mentoring                                    Solicitud de estudiante para tutoría en linea con EYM
1807 Crenshaw Blvd. Los Angeles California 90019
(323) 840-3556 and 213 487-2310 (cell)
http://www.educatingyoungminds.org/

For California registrations only!

Parents must complete and submit  the following application with their child/children.
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Email *
Program(s) you wish to apply for. Check all that apply *
Required
Date of Application | Fecha de solicitud *
MM
/
DD
/
YYYY
Student Name First and Last | Nombre de estudian *
Student's Address - Street Address, City, State, Zip code| Domicilio de estudiante *
Time Zone
Clear selection
School Attending | Nombre de escuela *
Student Grade | El grado  *
Birth Date (MM/DD/YYYY) *
Student Phone Number / Email Address | Número de teléfono *
What subject(s) are you registering for? *
Required
Share your current grades in difficult  subjects.  ** Please answer honestly, it's important because it tells us how much support you may need. We are here to HELP you, not judge you!! We believe in YOU!!!!  Provide subject(s) and grade. Ex.. Algebra-C *
Check All That Apply  
How did you hear about EYM?
Do you have a computer with a webcam? ¿Tienes una computdora con una camera de web? *
Do you have internet at home? ¿Tienes aceso de internet en tu casa? *
Does this student participate in a free lunch program? | ¿Participa este estudiante en un programa de almuerzo gratis? *
Total number of people in the student's household | El número de personas en el hogar del estudiante
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Total number of people in the student's household | El número de personas en el hogar del estudiante
Number of siblings | Numero de hermanos/hermanas
Father's Name  First and Last| Nombre del padre *
Father's phone number if applicable *
Mother's Name First and Last | Nombre de la madre *
Mother's phone number *
Parent's Nationality (Optional)
Emergency Contact name / phone number /email *
Tell us something about yourself. What are your goals and interest? *
Parents thank you for applying to EYM Live 4.0 | Gracias por solicitando
You may receive a call or email from one of our EYM staff members regarding your student's application.

By submitting this agreement,  you agree EYM reserves the right to terminate tutoring / mentoring sessions at their discretion.

Recibirá una llamada de uno de nuestros profesores en relación con la solicitud de su estudiante y entrenado para utilizar el servicio de tutoría en línea.
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