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Student Application & Needs Assessment
Please complete the following information for the application and needs assessment.
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First, Last Name and Middle Initial:
Address (include City, State and Zip):
Home Phone:
Cell Phone:
Email Address:
Temple:
Pastor:
Gender:
Clear selection
Age:
Grade:
Parent/Legal Guardian:
Parent Phone Number:
Parent Email Address:
Schedule - List days you are available:
Indicate available times for days above:
Preferred tutoring platform:
Clear selection
Preferred virtual platform you have access to:
Clear selection
List all subjects you need assistance with (Check all that apply):
Other subjects not listed above:
How might a tutor be most helpful to you? (Check all that apply):
Other assistance not listed above (Please describe):
What do you know about the way(s) you learn best that could help your tutor work effectively with you?
Besides tutoring, what other strategies/resources will you use to do well?
Additional comments for your tutor:
Student Name:
Parent/Guardian Name:
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