Tutor Me Program 2018 Summer Enrichment Program
Mission: To provide 1:1 tutoring and mentoring services to students during the summer to enhance their academic success and get them mentally prepared for the 2018-2019 school year.

Sessions are given by appointment only and created to fit your schedule. All sessions are given twice a week at 30 minutes per sessions.One application per student. All sessions are $15.00 per hour, students receive 2 sessions per week. Remember that once you set and accept your child's 1:1 tutoring/mentoring appointment, then you are legally responsible for paying for that session rather you keep it or not. There is a zero tolerance policy for parents/guardians that make appointments and do not show up for them. Sessions are given at a public library.

Student's Name:
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Date of Birth
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Age
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Grade going into?
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Legal Parent/Guardian Name(s):
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Are you the legal guardian of this student and assume all responsibilities?
Address, City, State, Zip:
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Contact Number (Cell/Home):
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Email Address:
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Parent/Guardian Employer’s Name:
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Employers’ Address:
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City/State/Zip Code:
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Emergency Contact Information: Please enter an emergency contact information for this student.
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Contact Phone (Cell/Home):
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Relationship:
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Your child's application must be completed before services can begin. This will serve as a starting point for the Tutor Me Program (to see where your child is at academically). Please be advised that your student must also to take an Entry and Exist Assessment Exam as a part of our data collection report.
Preferred Sessions: Limit up to 2 sessions per week
Please check here for your consent to take pictures and video of your student’s participation in the program and to be used solely for media content.
Subjects Needing Tutoring In (Limit 2) :
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Signature (Please type your name below):
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Date Signed:
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