Accelerating Student Achievement Across America
Program(s) Programs you wish join check all that apply
EYM Onsite - Crenshaw location
EYM Live 4.0 (Virtual)
Summer Camp Access (Virtual & non-virtual)
CALI- College Access & Life Skills/ SAT (Virtual & Non-virtual)
Parent names (mother & father) , email, phone number (work & home)
Student First Name
Student Last Name
Student Phone number
Home Address City, State, Zip Code
Current School ( Name & Address)
Pacific Standard Time (Los Angeles)
Central Standard Time (Chicago)
Mountain Standard Time (Phoenix)
Eastern Standard Time (New York)
Subject(s) you need help with, check all that apply
Biology / AP Biology
Pre k - 3rd Math, English, Science, & Reading Comprehension
Preferred Help Schedule (check all that apply)
Morning (Basic Math)
Afternoon (Basic Math)
Evening (Basic Math)
Morning (Algebra I & II)
Afternoon (Algebra I & II)
Evening (Algebra I & II)
Morning (English ESL)
Afternoon (English ESL)
Evening (English ESL)
Morning (Biology / AP Biology)
Afternoon (Biology / AP Biology)
Evening (Biology / AP Biology)
Morning (Organic Chemistry)
Afternoon (Organic Chemistry)
Evening (Organic Chemistry)
Morning (Calculus I & II)
Afternoon (Calculus I & II)
Evening (Calculus I & II)
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!!!!
Check All That Apply
Student is falling behind in the subject(s)
Student is failing the course(s)
Student is being forced to register by a parent / guardian
Student is making C's and feels that's good enough
Student has failed test in this subject(s)
Student has no textbook for this subject(s)
No WiFi in the home
Student does not have a computer
Student works from his/her phone
Student attends a Title School
Student qualifies for free lunch
Family qualifies for food stamps / government assistance
Student resides in single parent home
Homeless / transitional housing
More than 4 are living in household
Family has been impacted financially and or emotionally by COVID-19
Student speaks Spanish Only
How did you learn about EYM?
Do you have a computer with a web camera?
Do you have internet at home?
Does this student participate in a free lunch program?
Total number of people in the student household?
Number of siblings?
Emergency Contact: Name, phone, number & email.
Tell us something about yourself. What are your goals and interest?
Student's Nationality (Optional)
Parent's Nationality (Optional)
By submitting this agreement, you agree EYM reserves they right to terminate tutoring / mentoring sessions if we believe it is not the right fit
A copy of your responses will be emailed to the address you provided.
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