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!

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