Excel Student Evaluation
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Email *
 Student’s Name *
 Parent’s Name *
Parent Email *
Phone *
Address *
School Attending *
Grade *
Why do you think your student is struggling?   
Please answer the following questions to the best of your ability.  
In what subject(s) is help needed?  
Please answer the following questions to the best of your ability.  
What are your expectations for tutoring? 
Please answer the following questions to the best of your ability.  
How do you expect your student to perform in school? 
Please answer the following questions to the best of your ability.  
How does your student handle stress? 
Please answer the following questions to the best of your ability.  
What does your student’s teacher(s) say about their performance in class? 
Please answer the following questions to the best of your ability.  
Do you or does your student’s teacher(s) have concerns about behavior while at school? 
Please answer the following questions to the best of your ability.  
Do you know the type of curriculum or textbook used in the classroom for the subject your student is having difficulty with? 
Please answer the following questions to the best of your ability.  
Has your student passed STAAR?
Has your student passed EOC for their grade level?
Grades 10-12   Will your student be taking the SAT or ACT? 
Grades 11-12   Will your student be taking TSI?  

Rate your student’s organizational skills.

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At Excel Learning Academy, we know that organization is critical to a student’s success.  We offer a two hour class that covers essential organizational skills, note-taking skills, and study skills coaching.  If your student would benefit from any of the above listed skills, and you would like additional information, please check the appropriate box:  

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Which of these is your student’s primary learning style?

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Please list any known learning differences or challenges.

Does your student have a 504 or IEP? 

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If so, what types of accommodations or modifications are recommended?
Only answer this question if you answered yes to the previous question. If you answered no simply put n/a,

Please describe your student’s personality and interests.

A personality inventory is a valuable assessment tool.  Personality inventories reveal information about an individual’s social traits, motivations, strengths, weaknesses, and attitudes.  At Excel Learning Academy, we believe they play an important role in helping individuals understand themselves, as well as helping identify ways a person perceives and processes information.  Investing in a personality inventory is a positive, beneficial tool your student will use for their educational career and for their lifetime.  Please indicate if you are interested in more information about a one-hour personality assessment and results consultation.  

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Which of these are of greatest interest to you and your student.

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Which days/hours will best fit your schedule for tutoring? 

Are there any additional expectations you have for your student or the tutor at Excel Learning Academy?

Does your student have any medical conditions, allergies, or personality differences Excel Learning Academy needs to be aware of? 

Is there any other information that would be beneficial for your Excel Learning Academy tutor to know about you, your family, or your student?

How did you hear about us?

A copy of your responses will be emailed to the address you provided.
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