Schedule a Session

“I don’t have a feeling of inferiority. Never had. I’m as good as anybody, but no better.
”

— Katherine G. Johnson

Student's Name

First Name

Last Name

Student's Age

Parent / Guardian (if applicable)

First Name

Last Name

Does the student seek professional exam preparation services?

If yes, please state the exam.

Course Needing Supplemental Instruction

Name of Course Instructor

Name & Author of Textbook for the Course

What is the student's current grade in the course?

What grade is the student striving to earn in the course?

How often would the student like to meet?

Is the student enrolled in or attending:

Name of Student's School / University

Has the student ever had an IEP or 504 plan?

If yes, please elaborate.

What does the student hope to gain from mathematics tutoring?

When would the student like to have their session?

Morning (9am - 12pm)

Afternoon (12pm - 3pm)

Late Afternoon (3pm - 6pm)

Evening (after 6pm)

What day(s) would the student like to have their session(s)?

Sunday

Tuesday

Wednesday

Thursday

Saturday

Email Address

Best Contact Phone Number

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