Accelerating Student Achievement Across America
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Program(s) Programs you wish join check all that apply
Parent names (mother & father) , email, phone number (work & home)
Student First Name
Student Last Name
Student Phone number
Student email
Grade Level
Home Address City, State, Zip Code
Current School ( Name & Address)
Time Zone
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Subject(s) you need help with, check all that apply
Preferred Help Schedule (check all that apply)
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!!!!
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How did you learn about EYM?
Do you have a computer with a web camera?
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Do you have internet at home?
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Does this student participate in a free lunch program?
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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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