Seeley Test Pros - Student Information
Academic Coaching/ Study Skills Tutoring
Student Name: *
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Parent Name: *
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Student Phone Number: *
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Parent Phone Number: *
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Student Email Address: *
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Parent Email Address: *
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City of Residence *
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Student's Grade Level *
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Student's School: *
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Student's Cumulative GPA: *
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Student's Current Math Course:
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Student's Current Science Course:
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Student's Current English Course:
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Student's Current Social Studies Course:
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Does this student take any advanced, honors, AP, or IB courses:
What subjects tend to be areas of strength for this student? *
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What subjects tend to be areas of concern for this student? *
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What struggles or challenges in life contribute to stress at school? Be as specific as possible (divorce, siblings, depression, eating disorders, bullying, etc.) *
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What specific issues would you like addressed by tutoring? Check all that apply. *
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Does this student have an IEP, 504 or learning plan? *
If you answered yes to the previous question, what kind of accommodations do they receive?
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What is the student's current motivation level for tutoring: *
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What style of tutoring would this student benefit most from? *
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Do you have a preference for a specific Seeley Test Pros tutor? If so, please list the name below.
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When does the student often have availability for tutoring?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
8:00am-3:00pm (During a free period at school
3:00pm-6:00pm
6:00pm-9:00pm
Unavailable this day
What location(s) could this student meet their tutor? *
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How many hours of tutoring does the student anticipate needing weekly? *
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For how long does the student anticipate scheduling tutoring? *
Has the student been tutored by another individual or company? If so, with whom or what company? *
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Has this student been referred to Seeley Test Pros by a specific individual? If so, please list their name(s): *
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How many hours of tutoring are you requesting at this time? Payment can be made by cash, check, Venmo or Paypal (5% fee). *
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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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