Today's Date
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MM
DD
YYYY
Name
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If your student prefers we use a nickname, please write that as their "First Name."
First Name
Last Name
Pronunciation
Student's Pronouns
Graduation Year
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School Attending
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Current Courses
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Student Cell Phone
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This is primarily used for emergencies or if someone is running late. This number will also receive appointment reminders.
(###)
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Primary Parent/Guardian Name
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First Name
Last Name
How should we pronounce your name?
Relationship to Student
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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
How should we pronounce your name?
Relationship to Student
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Preferred Contact Phone
(###)
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Address
Skip if same as above.
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 goals of this tutoring?
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Please elaborate on any test scores, learning objectives, grades, college admissions goals, etc. your student is hoping to achieve.
What should we know about this student?
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Please state any learning differences or disabilities, strengths, weaknesses, circumstances, personality traits, etc. that would we should know to make the tutoring more effective. This information is always kept confidential.
Does the student receive learning accommodations (e.g. 504, IEP, etc.) at school?
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Has this student received tutoring before?
If yes, please indicate with whom they tutored, for what, for how long, and anything notable that did/didn't work well.
When is the student available for tutoring sessions?
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Please state days of the week, times of day, etc. If availability changes from one month to the next, please say so! The more specific, the sooner we can get them set up! We want to make sure they are paired with a tutor or tutors whose availability matches theirs.
How often would the student like tutoring?
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—Please state if you want tutoring 1x every other week, 1x/week, 2x/week, etc. Most tutoring sessions run for about an hour.
When can the student start tutoring?
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Please state the date that is the earliest tutoring can/should begin.
Preferred Tutoring Format
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What extracurricular activities does the student participate in?
—Please indicate any sports, clubs, or hobbies the student participates in.
—Also note if the student is being recruited for a college sport or plans to.
Does the student have a preference for SAT or ACT?
Does student have baseline test scores we can use to gauge a rough starting aptitude??
Unsure
No
Not Applicable
Yes: Official ACT test scores
Yes: Official SAT test scores
Yes: Practice ACT test scores
Yes: Practice SAT test scores
Yes: Pre-ACT test scores administered by the school in 10th grade)
Yes: Practice PSAT test scores
Yes: PSAT-10 test scores administered by the school in 10th grade
Yes: Official PSAT/NMSQT test scores administered by the school in October of 11th grade
When does the student plan on taking the ACT / SAT / PSAT?
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.
