Client & Student Information

Parent Information

1st Parent/Guardian Name*

First Last

1st Parent/Guardian Phone Number*

1st Parent/Guardian Phone Type*

1st Parent/Guardian Alternate Phone Number

1st Parent/Guardian Alternate Phone Type

1st Parent/Guardian Email*

1st Parent/Guardian Address*

Street Address City State ZIP Code

2nd Parent/Guardian Name

First Last

2nd Parent/Guardian Phone Number

2nd Parent/Guardian Phone Type

2nd Parent/Guardian Alternate Phone Number

2nd Parent/Guardian Alternate Phone Type

2nd Parent/Guardian Email

Does the 2nd parent have the same mailing address?

Yes
No

2nd Parent/Guardian Address

Street Address City State ZIP Code

Additional Parent/Guardian Information (Optional)

1st Student Information

1st Student's Name*

First Last

1st Student's Pronouns (optional)

Optional: Please indicate your student's preferred pronouns.

1st Student's Birthdate (optional)

MM

DD

YYYY

1st Student's Grade*

1st Student's School*

1st Student's Email (optional)

1st Student's Phone (optional)

Which format of schooling is Student #1 attending?*

100% In-person
100% Online/remote
Home schooling

1st Student Needs Tutoring In (check all that apply):*

1st Student's Other Tutoring Needs

Please describe other areas for tutoring.

1st Student's Strengths*

Please describe the student's areas of strength

1st Student's Weaknesses/Areas for Improvement:*

Please describe the student's weaknesses/areas for improvement:

1st Student's Learning Issues or Challenges*

Please describe any learning issues or challenges that the student may have. If there are none, please type "none."

1st Student's IEPs, 504 Plans and/or ALPs*

Please list any IEPs (Individual Education Plans), 504 Plans or ALPs (Advanced Learning Plans) that the student may have. If there are none, please type "none."

1st Student's Hobbies or Areas of Interest*

Please list any hobbies or areas of interest that the student may have.

1st Student's Personality Traits*

Please describe student's personality traits. This helps tutors relate to and form a connection with the student.

1st Student's Main Goal(s) For Tutoring*

Please describe your main goal(s) for tutoring. More specific goals can be helpful.

1st Student's Preferred Learning Style (if known; check all that apply):*

Visual
Verbal
Auditory
Kinesthetic
Tactile
Unknown

If you don't know what learning style(s) best describe the student, they can take an online test available at http://goo.gl/cfNs0U

1st Student Teacher #1 Name. If you do not know your teacher's name, please enter a parent/guardian name and email. We prefer teacher info if possible however and will respect the parent/guardian's wishes for contacting or not contacting the teacher.*

1st Student Teacher # 1 Email*

1st Student Teacher # 1 Google Classroom/Schoology/Website Link (Optional)

Teachers often provide homework information on a Google Classroom, Schoology or other website; this is useful information for a tutor to have.

May we contact Teacher #1?*

Yes
No

Tutors sometimes need to contact teachers to clarify homework assignments and/or assess student's progress.

1st Student Teacher #2 Name

1st Student Teacher # 2 Email

1st Student Teacher # 2 Google Classroom/Schoology/Website (Optional)

Teachers often provide homework information on a Google Classroom, Schoology or other website; this is useful information for a tutor to have.

May we contact Teacher #2?

Yes
No

Tutors sometimes need to contact teachers to clarify homework assignments and/or assess student's progress.

1st Student Teacher #3 Name

1st Student Teacher # 3 Email

1st Student Teacher # 3 Google Classroom/Schoology/Website (Optional)

Teachers often provide homework information on a Google Classroom, Schoology or other website; this is useful information for a tutor to have.

May we contact Teacher #3?

Yes
No

Tutors sometimes need to contact teachers to clarify homework assignments and/or assess student's progress.

1st Student Additional Information

Is there any additional information that you would like a tutor to know about this student?

2nd Student Information

Would you like to enter information for a 2nd student?

No
Yes

2nd Student's Name

First Last

2nd Student's Pronouns (optional)

Optional: Please indicate your student's preferred pronouns.

2nd Student Birthdate (optional)

MM

DD

YYYY

2nd Student's Grade

2nd Student's School

2nd Student's Email (optional)

2nd Student's Phone (optional)

Which format of schooling is your Student #2 attending?

100% In-person
100% Online/remote
Home schooling

2nd Student Needs Tutoring In (check all that apply):

2nd Student's Other Tutoring Needs

Please describe other areas for tutoring.

2nd Student's Strengths

Please describe the student's areas of strength

2nd Student's Weaknesses/Areas for Improvement

Please describe the student's weaknesses/areas for improvement.

2nd Student's Learning Issues or Challenges

Please describe any learning issues or challenges that the student may have. If there are none, please type "none."

2nd Student's IEPs, 504 Plans and/or ALPs

Please list any ILPs (Individual Learning Plans), 504 Plans or ALPs (Advanced Learning Plans) that the student may have. If there are none, please type "none."

2nd Student's Hobbies or Areas of Interest

Please list any hobbies or areas of interest that the student may have.

2nd Student's Personality Traits

Please describe student's personality traits. This helps tutors relate to and form a connection with the student.

2nd Student's Main Goal(s) For Tutoring

Please describe your main goal(s) for tutoring

2nd Student's Preferred Learning Style (if known; check all that apply):

Visual
Verbal
Auditory
Kinesthetic
Tactile
Unknown

If you don't know what learning style(s) best describe the student, they can take an online test available at http://goo.gl/cfNs0U

2nd Student Teacher #1 Name

If you do not know your teacher's name, please enter a parent/guardian name and email. We prefer teacher info if possible however and will respect the parent/guardian's wishes for contacting or not contacting the teacher.

2nd Student Teacher #1 Email

2nd Student Teacher #1 Google Classroom/Schoology/Website (Optional)

Teachers often provide homework information on a Google Classroom, Schoology or other website; this is useful information for a tutor to have.

May we contact Teacher #1?

Yes
No

Tutors sometimes need to contact teachers to clarify homework assignments and/or assess student's progress.

2nd Student Teacher #2 Name

2nd Student Teacher #2 Email

2nd Student Teacher #2 Google Classroom/Schoology/Website (Optional)

Teachers often provide homework information on a Google Classroom, Schoology or other website; this is useful information for a tutor to have.

May we contact Teacher #2?

Yes
No

Tutors sometimes need to contact teachers to clarify homework assignments and/or assess student's progress.

2nd Student Teacher #3 Name

2nd Student Teacher #3 Email

2nd Student Teacher #3 Google Classroom/Schoology/Website (Optional)

Teachers often provide homework information on a Google Classroom, Schoology or other website; this is useful information for a tutor to have.

May we contact Teacher #3?

Yes
No

Tutors sometimes need to contact teachers to clarify homework assignments and/or assess student's progress.

2nd Student Additional Information

Is there any additional information that you would like a tutor to know about this student?

Additional Information

Requested Location for Tutoring Sessions (check all that apply)*

Now that places are opening back up, we have many options for tutoring again! Please keep in mind that locations outside of a Golden address typically include driving fees (unless the tutor happens to live in your area or is coming from a location close to you).

Client & Student Information

Please provide the following information so that we can ensure the best possible tutor match for your student(s).

Parent Information

1st Student Information

2nd Student Information

Additional Information