Tutoring Registration Form
One-on-one Tutoring for Autistic Students
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Student's Name *
Parent/Guardian Name *
Phone number *
Email address *
Academic Profile - Please check all that apply *
Please describe the academic skills/subjects you would like us to work on with your child *
What is the outcome you would like to see if your child is to participate in this tutoring program? *
Please list any diagnoses (or suspected diagnoses) your child may have which may affect their academic skills
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