Request edit access
Academic Mentor Program Registration Form
The purpose of The Academic Mentoring Program is to provide teens with a one on one experience in achieving academic success. This program will be more involved than just tutoring. The role of the academic mentor is to hold weekly meetings with the teen on zoom, hold them accountable to their school work, teach them study skills, help them set academic goals, and align them with the appropriate tutors, if they are unable to tutor a subject themselves.
Sign in to Google to save your progress. Learn more
Student First and Last Name: *
Student School Attending and Grade: *
Parent First and Last Name: *
Parent Email Address: *
Parent Phone Number: *
Academic Progress website/platform (i.e powerschool):
Login Username and Password:
Academic subjects and areas that your student is struggling with: *
Academic subjects and areas that your student excels in: *
What is your teens class schedule? (Please list all classes, with the teacher's name) *
Who is your Academic Counselor at your school? *
Do you have an IEP? (if yes, please be sure to email copy to The Launch Pad Tutoring Center at *
Before COVID-19, were you involved in after school activities or sports? If so, please list the activity and how often you were involved in that program. Would you be interested in engaging in a new extra-curricular program offered online through The Launch Pad? *
I understand that by signing this form I am giving The Launch Pad Staff permission to view my child's academic progress and grades. I also understand that this information will be kept confidential *
Clear form
Never submit passwords through Google Forms.
This form was created inside of Prescott College. Report Abuse