Nursing Tutoring Student Intake Form
  Thank you for your interest in tutoring with Sinoe Medical Association. This short survey will help us understand your academic needs, learning goals, current challenges, and preferred tutoring format. Your answers will help us prepare the best tutoring plan for you, whether you need help with Anatomy and Physiology, Pathophysiology, Pharmacology, ATI, NCLEX preparation, or general nursing course support.  

Please provide the following information to help us tailor your tutoring program effectively.
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  School / College / University:  
Full Name
Email Address
Phone Number
What is your current program level?
Clear selection
  Are you currently a PGCC or former PGCC student?  
Clear selection
What specific subjects or areas of nursing are you seeking tutoring in? (Select all that apply)
What is your primary goal for seeking tutoring assistance?
Clear selection
  Do you want tutoring focused on:  
Clear selection
On a scale of 1 (Not confident) to 5 (Highly confident), how would you rate your current overall confidence in nursing coursework?
Not confident
Highly confident
Clear selection
Please describe any specific challenges or learning obstacles you are currently facing.
Which days and times generally work best for your tutoring sessions?
Evening (6:30pm-8:30pm)
afternoon 12:30pm - 3 pm
Friday
Saturday
Sunday
  Preferred Tutoring Format  
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Preferred Start Date for Tutoring
MM
/
DD
/
YYYY
How did you hear about our tutoring service?
Payment plan
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Submit
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