Registrant Information

Full name, phone number, and email of the person enrolling the student(s)

Number of Students

Total number attending

Student Information

Name, age, and current grade level of each student

Preferred Session Date & Time

Monday–Thursday: 7 AM–7 PM

Friday–Sunday: Available upon request

Tutoring Location

My home, your home, online (Zoom), or other (please specify)

Selected Package

Package name (A–V) and number of packages purchased

Subject(s) of Study

Please list the subject(s) each student needs help with

Student Needs & Goals

What are the student’s strengths and areas for improvement? Are there specific academic goals or challenges we should be aware of?

Additional Comments or Special Requests

Any other information that would help us support the student(s) effectively