New Student Enrollment Form Preferred Name * Parent First Name Last Name Email * Preferred Name Student First Name Last Name Student Birthday * MM DD YYYY Student current grade * Pre-K Kindergarten 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th Subject matter (Select all that apply) * Math Reading Sciences Other Does the student have an IEP or 504 plan? * IEP 504 plan Both Niether I don't know When would you like to begin services? * MM DD YYYY How often would you like tutoring services? * Weekly (Intervention) Bi-weekly (Progress monitoring) Monthly (Refresher) As needed Is there anything else our tutors should know about the student's learning abilities? (Strengths, areas of challenge, favorite subject in school etc.) Thank you for
