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Intake Form: G.I.F.T. - Gillison's Investigative Forward Thinkers, llc
(Orton - Gillingham Tutor - A/OGA) - Thank you for completing this 9 question Intake Form!
* Indicates required question
Email
*
Record my email address with my response
1. How did you hear about us?
*
G.I.F.T. - Gillison's Investigative Forward Thinkers, LLC website
Orton-Gillingham Academy - Find a Teacher/Tutor (emailing the Academy office)
Camperdown Tutor Referral List
Lakes and Bridges Charter School referral list
There is Hope Counseling
Alfreda Gillison Miller
Friend/colleague
Email
Internet Search
Alignable
Other
Required
2. What is your name (First & Last)
?
*
Your answer
3. What is your relationship to the student?
*
Choose
Mother
Father
Self
Guardian
Grandmother
Grandfather
Sister
Brother
Teacher
Friend of Family
Other
4. What is the name (First & Last) of the student?
*
Your answer
5. What is the grade level for the student?
*
Choose
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Undergraduate Student
Adult Learner
6. How may I help you?
*
Your answer
7. Which tutoring days are best?
*Note: Students must receive at least two days a week.
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Required
8. Which tutoring time is best?
*
Choose
8:00am
9:00am
10:00am
11:00am
1:00pm
2:00pm
4:30pm
5:20pm
3:00pm
4:00pm
Other agreed upon time
9. What is your
contact phone number
?
*
Your answer
For Your Reference:
www.gift-gillisonsinvestigativeforward-thinkersllc.org
GIFTfor1in5@gmail.com
Send me a copy of my responses.
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