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Parent Intake Survey
Please complete the survey so that I can better assist your child with his/her literacy needs. Thank you for taking the time to complete this survey I look forward to watching your child grow and meet their literacy goals.
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Email
*
Your email
Please select a tutoring option
*
In person (Location TBD)
Virtual Tutoring
3:1 Learning Pod
Student Name
*
Your answer
What grade is your child in/going in to?
*
Your answer
Which school district does your child attend?
Your answer
What are your learning goals for your child while working with me?
*
Your answer
What subject area is your child most successful in at school?
*
Reading
Math
Science
Writing
Other
What area has your child's teacher suggested that they could use improvement? (This could include behavior management)
*
Your answer
What is your child's favorite thing about school?
*
Your answer
What are your child's hobbies or interests?
Your answer
Does your child have any allergies? If so, please list all below.
Your answer
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