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Student First Name *
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Student Last Name
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Student Phone Number *
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Student Personal Email Address *
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Contact Parent/Guardian First Name *
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Contact Parent/Guardian Last Name
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Contact Parent/Guardian Phone Number *
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Contact Parent/Guardian Personal Email Address *
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Title of Class that Student Needs Help In *
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Last Name of Teacher of that Class
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Student Needs Help As Soon As *
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Does the tutor gender matter?
If the students speaks a language other than English AND needs a tutor who speaks that language, please type the language below.
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Preferred Meeting Place
Can the tutor contact you to make arrangments to meet for the first time? *
How would the student prefer to be contacted? *
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How would the parent prefer to be contacted? *
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By checking this box, I understand that the tutor cannot be paid in cash or gift cards for their services as long as they are counting it as NHS tutoring/overflow service hours. Students can continue to receive free tutoring from another tutor who needs the hours (just resubmit a request at that time). *
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This form was filled out by a teacher (with permission from the student or their guardian). *
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