BEAM Tutoring- Summer Intake Form

Thank you for your interest in BEAM’s academic intervention program.

BEAM specializes in supporting elementary students who may be struggling to access learning in traditional school settings and who benefit from personalized, relationship-centered instruction.

This form helps us understand your child’s academic needs, learning profile, and goals so we can determine fit and design meaningful support.

BEAM's Academic Intervention Program is lead by Karen Bures, Masters in Trauma Informed Education, Special Education Certified, and certified Reading Specialist.

We look forward to learning more about your child. 

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Email *
Student Name *
Student Date of Birth *
Child's race and ethnicity:
Does your child have any medical diagnosis, mental health challenges, support needs or disability we should be aware of?

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Entering grade and school

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What are your child's special interests or hobbies? *

Parent/Guardian Name

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Phone Number

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Preferred Method of Communication

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What subject areas does your child need support in?

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Required

What specific academic concerns are you noticing?

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Does your child have an IEP or 504 plan?

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Required

When learning feels hard, my child typically:

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Required

Has your child experienced shortened school days, suspensions, or reduced academic access?

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Required

What would success look like for your child in the next 3–6 months?

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Please select your intended enrollment option, sessions are 1 hour long

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BEAM offers academic sessions during weekday daytime hours.

Please indicate your interest below. Selection does not guarantee availability but helps us plan responsibly.

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Required

I authorize BEAM to communicate with my child’s school team for the purpose of coordinating academic support.

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Please indicate your photo permissions:

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Required

Submission of this intake form does not guarantee placement.

All responses are reviewed individually to determine program fit and availability. Karen will follow up with you regarding next steps and then a formal enrollment agreement and Release of Information (ROI) will be sent for signature to confirm placement.

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Required
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