Registration Form

Today's Date

Parent 1 First Name*

Parent 1 Last Name*

Parent 1's Phone*

Parent 1 Email*

Second Parent First Name

Second Parent Last Name

Second Parent Mobile Phone

Second Parent Email

Address line 1*

Address line 2

City*

State*

Postal code*

Student First Name*

Student Last Name*

Preferred Name

Student Gender*

Preferred Pronouns

School*

High School Graduation Year*

Student Phone Number*

Student Email*

Requested start date

Current availability on Sundays

Current availability on Mondays

Current availability on Tuesdays

Current availability on Wednesdays

Current availability on Thursdays

Current availability on Fridays

Current availability on Saturdays

Notes about availability

If already assigned, select tutor or make tutor request

2nd Tutor Request

Location First Request*

Location Second Request

Tutoring Type

Which test is the preparation for, if decided?

If Academic Coaching (not test prep), which subject?

Select test subjects for preparation

SAT dates your child plans to test

ACT dates your child plans to test

Official SAT scores (include reading/writing and writing scores)

Soph PSAT (include subscores)

Junior PSAT (include subscores)

Pre-ACT (include subscores)

Official ACT scores (include English, math, reading, and science subscores)

Goal scores

Comments about child's academic performance, testing performance, strengths, areas for improvement, learning style, etc

College/School list

Math courses taken 8th grade - present

To schedule an SAT or ACT diagnostic, select a Sunday that works for your child and we'll confirm.

Describe any previous test prep

Describe special needs, concerns, or allergies

For students with disabilities, describe the disability and include details about special accommodations

Whom may we thank for referring you to us?

Questions? You may include them here.

Payment Plan*

Payment Info

Payment Policies: I understand that if I have an overdue invoice, my credit card will be charged the full balance.*

Policies: I have read and understand the cancellation, attendance, and discontinuation policies.*

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