Application for Brookline Tutor Mentor Program
Student Full Name (First, Last) *
Your answer
Student's Gender *
Student's School *
Your answer
Student's Grade *
Student Email *
Your answer
Student Phone Number
Your answer
Parent/Guardian Full Name (First, Last) *
Your answer
Parent/Guardian Relation to Student *
Parent/Guardian Email *
Your answer
Parent/Guardian Phone Number (Where can they be reached quickly?) *
Your answer
What email would you like to be contacted at? *
Your answer
Students: What academic areas do you need help in? *
Your answer
Students: What are your interests? List academic and after-school/extracurricular activities, hobbies, sports, and anything else that you have an interest in! *
Your answer
Parents: What would you like your child to achieve? *
Your answer
Students: How available are you on Sundays (1-3 pm?) *
Students: If you are not always available on Sundays, what days of the week are you available?
Your answer
Students: Do you speak a language besides English? If English is not your first language/you would rather be tutored in another language, please specify. *
Parents: If English is not your primary language, please let us know here.
Your answer
Thanks for applying to the BTMP!
We hope to see you at our first meeting on Sunday December 9th at 1:00 pm. Please bring a pencil, eraser, and any notebooks/materials you'd like to use.
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