The Evolved Education Company Student Profile Intake Form
This form will take about 10 minutes to complete. It will greatly help us to best serve your family. We look forward to partnering with you!
Email address
Your full name
Your answer
Your child's full name
Your answer
Your Home Address
Your answer
Your Child's School
Your answer
Your Child's Grade
Your answer
Your Phone Number
Your answer
Please tell us how you learned about the Evolved Education Company
When would you like to begin tutoring?
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Which days and times would you like meet?
Your answer
Would you like to have sessions in your home? If not, where would you like to meet?
Your answer
Your Child's Development
Please briefly tell us about each area of your child's development. We use this information to ensure that we are addressing all areas of your child's experience as a student. For instance, if your child's work space at home is not conducive to studying, that may interfere with the ability to study independently; or if your child's experience in a class has not been working well, we would want to know about that as well. If you are unsure of any aspect, do not worry; we can help you to uncover information during our intake call and/or as we begin to work with your child.
Please tell us about your child's academic history (strengths and challenges).
Your answer
Do you know your child's learning style or preference? How does your child like to learn? Has your child had any tutoring in the past? To which type of adult does your child best respond?
Your answer
Tell us about your child's experiences at school (where has your child gone to school in the past and where does your child go to school now; and, how would you describe each school experience?)
Your answer
Tell us about your family values regarding your child's education and this support program. What goals do you have for a tutoring program? 
Your answer
Let us know if you have any concerns about your child's social, emotional and/or physical development. Please visit www.evolveded.com/sepaq.html to take our free assessment to find out how your child is developing socially, emotionally and physically. Please report your child's score here.
Your answer
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