Private Tutoring Application

Student Name

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Current Grade In School

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School

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Parent Name

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Parent Email

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Phone

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Home Address

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Skype Name

(if you want to do the consultation or any sessions via Skype)

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PSAT (date taken)

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PSAT Results --Reading / Writing

gives scores from the most recent test

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PSAT Results --Math

gives scores from the most recent test

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Has the student taken the SAT?

(If so, please list test dates)

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SAT Results -- Reading / Writing

give the highest score earned

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SAT Results -- Math

give the highest score earned

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Has the student taken the ACT?

(If so, please list test dates)

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ACT Results -- Composite

give the highest score earned

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ACT Results -- English

give the highest score earned

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ACT Results -- Math

give the highest score earned

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ACT Results -- Reading

give the highest score earned

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ACT Results -- Science

give the highest score earned

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What are your goals for private tutoring?

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Are there any special circumstances that may impact tutoring?

(learning differences, test anxiety, physical or mental health issues)

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Have you done any test preparation before? If yes, please describe what you did and the results.

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Are you interested in individual tutoring or private group tutoring (a group made up of your friends / neighbors)?

Individual Tutoring
Private Group Tutoring

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If you are interested in individual tutoring, which program do you think best suits your needs?

$4195 full program (11 meetings)
$2295 basic program (6 meetings)

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If you are interested in group tutoring, indicate the program you think best describes your group.

Groups of 2-3 $1495 per student (6 meetings)
Groups of 4-5 $1195 per student (6 meetings)
Groups of 6 or more $1195 per students (8 meetings-- more time than with a smaller group)

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(Group Tutoring Only) Have you discussed the possibility of group tutoring with other potential group members?

yes
no

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(Group Tutoring Only) Please list prospective group members:

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(Group Tutoring Only) Have you discussed specific scores or score goals with other members of the group? If so, what are the general score ranges of group members?

It is possible to teach a group with varying ability levels; however, private groups tend to be most productive when all members have similar strengths, weaknesses, or goals. I encourage you to discuss previous scores and / or current goals with the members of your group.

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Please indicate where we will meet:

Via Skype
At our home
At another location in the Sugar Land / Houston area

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Rank your top four time choices

Sundays 7-9 pm ___ Mondays 4-6 pm ___ Mondays 7-9 pm ___ Tuesdays 4-6 pm ___ Tuesdays 7-9 pm ___ Wednesdays 4-6 pm ___ Wednesdays 7-9 pm ___

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Is there anything else I should know?

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What questions do you have for me?

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