Student First Name: *

Student Last Name: *

Parent Name: *

Student Phone Number: *

Parent Phone Number: *

Student Email Address: *

Parent Email Address: *

Student’s Graduation Year: *

What upcoming test is the student registered for/plans to register for? (Example: February ACT, March SAT, etc.) *

City of Residence: *

Student's High School: *

Student's Cumulative GPA: *

Student's Current Math Course: *

Student's Current Science Course: *

Does this student take any honors, AP, or IB courses:

What subjects tend to be areas of strength for this student? *

What subjects tend to be areas of concern for this student? *

Has this student taken an official ACT and/or SAT? *

If you answered yes to the previous question, what were the student's scores (please list specific individual section scores, if possible)?

Does this student receive accommodations on the ACT and/or SAT? *

If you answered yes to the previous question, what kind of accommodations do they receive?

What colleges or universities is the student currently interested in? (if undecided, list N/A) *

Has the student completed any previous ACT, SAT, or PSAT tutoring or test preparation classes? If so, with whom or what company?

Has this student been referred to Seeley Test Pros by a specific individual? If so, please list their name(s):

What is the student's current motivation level for tutoring: *

What style of tutoring would this student benefit most from? *

Does this student have a preference of gender for their tutor? *

Do you have a preference for a specific Seeley Test Pros tutor? If so, please check the name below.

What is your expectation for the student's ability to complete homework each week: *

When does the student often have availability for tutoring?

If during a free period at school, what is the time of day?

What location(s) could this student meet their tutor? *

Which tutoring package are you requesting? Payment can be made by cash, check, Venmo or Paypal (5% fee). *

Seeley Test Pros will attempt to accommodate scheduling changes, but only with a minimum of 24-hours notice prior to the scheduled tutoring appointment. Notice must be provided by phone, directly to the instructor. If email and/or text communications of the cancellation are provided, such are only effective upon the receipt and responsive confirmation by the instructor. Cancellations with less than 24-hours advance notice will result in a charge of the full amount of the scheduled time. In the case of inclement weather (e.g., snowstorms) and emergencies, Seeley Test Pros will make a determination on fee waivers for late cancellations due to emergencies. *

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