Room 17 Financial Assistance Request Form

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Room 17’s WIN (What I Need) Tutoring and Summer Math Camp services are opportunities for “roomies” to sustain and extend age-appropriate skills and strategies. Our goal is to lessen the effects of the dreaded “summer brain drain” and eliminate math phobia. Through interactive games, individualized support, and real life problem solving opportunities, roomies experience math in a way that promotes confidence and individual thinking. With Room 17, keeping the learning fun is a priority! You can read more about both of these services by visiting our site www.room17math.com.

We know that families may want to offer their children learning opportunities that may not always be possible, given the ups and downs of "life". If you have a child who is interested in our WIN Tutoring or Summer Math Camp and in need of financial assistance, please take a moment to complete this short request.

Assistance will be awarded based on availability. It is important to remember that assistance is not guaranteed, but we will do everything we can to accommodate all roomies!

With the help of our community donors and generous sponsorships, we hope to be able to offer a plan that works for your family soon!

~Sara and Monica~ Room17 Math, Inc.

Email *

First and Last Name of Parent/Guardian *

Phone Number *

First and Last Name of Student(s) *

Home Address *

Grade of Student(s) and/or course topic: *

How did you hear about Room 17? *

Which service option(s) are you interested in: *

Full 5 Weeks of Summer Math Camp

One hour a week WIN Tutoring with a teacher ($240 a month)

One hour a week WIN Tutoring with a peer tutor (highly qualified and trained high school or college student)($150 a month)

Two hours a week WIN Tutoring with a peer tutor (highly qualified and trained high school or college student)($300 a month)

Other:

Required

Why do you feel your child would benefit from our services? *

Why should you be considered for a financial aid package? If you desire a full or partial sponsorship please indicate, if you are comfortable sharing. *

Is there anything else Room 17 should know about your request or child?

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