Academic Help Form for Educating With Purpose
Please complete this form if you have a child that needs academic help. ONLY ONE SUBJECT PER HOUR. Upon completing this form, you will be contacted by a member of our team.

Many thanks and we look forward to helping your scholar!

EDUCATING WITH PURPOSE
Info@EducatingWithPurpose.com
@EducWithPurpose

Student Name *
Your answer
Current Grade Level *
Your answer
Strongest Subject / Weakest Subject *
Your answer
Hobbies *
Your answer
Current feelings towards school / learning *
Your answer
Extracurricular Activities *
Your answer
Requested Days for tutoring help *
Your answer
Requested Time *
Your answer
Subject(s) requested (ONLY ONE SUBJECT PER HOUR) *
Your answer
Does the student participate in any school tutorials or intervention programs?
Your answer
If you answered yes to the above question, please list the programs or tutorials here:
Your answer
What is your focus for the tutoring session: academic skills deficit, homework help, introduction of skills, etc *
Your answer
Parent Name *
Your answer
Full Address *
Your answer
Mobile / Phone Number *
Your answer
Email Address *
Your answer
Emergency Contact & Number *
Your answer
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