Higher Heights Tutoring Intake Form 2021
Welcome to your Tutoring Program offered through Higher Heights Youth Empowerment Programs, Inc.

Our tutoring program gives children extra opportunities to improve their Math, English/Reading, Science, and Social Studies skills.

Your child will meet individually with a tutor. These tutoring sessions will take place once per week (per subject as needed). Each session will last about 60 minutes.

Tutoring sessions will be scheduled so that your child does not miss important classwork.The goal of these tutoring sessions is to help your child to become a more skilled and confident student.

Please complete the attached form so we can better prepare your individualized tutoring program for you.
Student First Name
Student Last Name
Student's Email address
Parent's Full Name
Parent's Email Address
Are you a case manager referring a student?
Clear selection
If so, please list your first and last name and email address.
If you are utilizing this service through UCA and you have been assigned a case manager, please list their full name below
Student's grade level
Clear selection
Please select the days you are interested in receiving tutoring. Each session is 60 minutes.
Please share the subject your child needs assistance in *
Name of your child's current school *
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