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Parent/Guardian First Name: Last Name:
Address:
Address Line 2:
City: Zip Code:
Home Phone: Cell Phone:
Work Phone: Email:
Best time to call:
Student First Name: Student Last Name:
Birth Date: Grade:
School:

Please check the following subject areas in which you have tutoring needs

Elementary
    Math
    Reading
    Spelling
    Other: Please Describe

Middle School
  Math
    Basic Math
    Pre-Algebra
    Algebra 1
    Algebra 2
  Science
    Physical Science
    Biology / Life Science
  Social Studies
    Social Studies / History
    Civics / Government
  English
    English
    Reading and Comprehension
  Other: Please Describe

High School
  Math
    Basic Math
    Algebra 1
    Geometry
    Algebra 2
    Pre-Calculus
    Trigonometry
    Calculus A/B
    Statistics
  Science
    General Science
    Anatomy / Physiology
    Biology
    Chemistry
    Environmental Science
    Physics
  Social Studies
    World History
    American History
    Civics / Government
    Economics
  English
    Reading and Comprehension
    English Composition
    English Grammar
    Literature
    Advanced English
    Other: Please Describe

ForeignLanguages
    French 1
    French 2
    French 3
    French 4
    German 1
    German 2
    German 3
    German 4
    Spanish 1
    Spanish 2
    Spanish 3
    Spanish 4
    Other: Please Describe

Test Prep
    ACT English and Reading
    ACT Math
    ACT Science and Reasoning
    GED
    SAT Math
    SAT Verbal
    State Achievement Tests
    Other: Please Describe

Other
    English as a Second Language (ESL)
    Other: Please Describe


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