Today's Date
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MM
DD
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Name
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Please write the student's preferred name.
First Name
Last Name
Student's Name Pronunciation
Student's Pronouns
Graduation Year
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School Attending
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Current Courses
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If filling this out in summer, please list the courses the student will be taking during the upcoming school year.
Student Cell Phone
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We will not contact the student directly until we’ve spoken with a parent and had an introduction session.
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Primary Parent/Guardian Name
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First Name
Last Name
Parent's Name Pronunciation
Relationship
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Preferred Contact Phone
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(###)
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Home Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Secondary Parent/ Guardian Name
First Name
Last Name
Parent's Name Pronunciation
Relationship
Preferred Contact Phone
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Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
What type of tutoring do you seek?
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What are the student’s goals for tutoring?
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Please elaborate on specific test scores, grades and/or college admissions goals.
What should we know about this student?
Do they have any special strengths, needs, or learning differences?
Note: This information is always kept confidential.
Does your student have extended time on tests at school?
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Has this student received tutoring before? If so, please explain with whom, for what, and for how long.
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Please also indicate what did or didn't work for this student with previous tutoring.
When is the student available for tutoring sessions?
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Please include days of the week, times of day, etc.
When can the student start this tutoring?
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Give a date that is the earliest tutoring can/should begin.
Preferred Tutoring Format
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What extracurriculars does the student participate in?
Please also indicate if the student plans to pursue recruitment for a sport in college.
Does the student have a preference for SAT or ACT?
When does the student plan on taking the ACT or SAT next?
How did you hear about Kay Tutoring?
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Terms and Conditions
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By checking this box, you're confirming that you've read and agree to Kay Tutoring's policies, which includes paying any fees incurred for services rendered or late cancellations/rescheduling. Our Policies & Services document is linked at the bottom of this webpage.
