Interest Form 
We want to get to know your scholar! 
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Student's Name 
Parent's Name 
Telephone Number 
Email 
Street Address 
City and State 
Zip Code 
Day of the week available for tutoring lessons 
Areas needed for tutoring 
Does your child need Social and Emotional Learning? If yes please explain areas of concern.
What are somethings your child enjoys doing or is very good at?
What are your child's greatest strengths in school?
What are your learning concerns for your child?
Does your child receive any special services?
Describe how your child learns best.
Is there anything else we should know about your child that would help us to be successful during tutoring?
Student's current grade level 
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