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QUESTIONNAIRE
Name
*
First
Last
Address
*
Street Address
City
State / Province / Region
Postal / Zip Code
Email
*
Phone
*
How often do you need a tutor?
*
Twice a Week
Weekly
1-2 Times a Month
What length of time?
Half Hour
Hour
What school does your child attend?
*
Wren Elementary
Hunt Meadows
Concrete Elementary
Powdersville Elementary
Other - Please Specify
Specify School
*
What grade is the student in?
*
PreK
Kindergarten
1st
2nd
3rd
4th
5th
What areas would you like help in?
*
General Reading
Handwriting
General Writing
Prompt Writing/TDW
Math
Homework Support
Other - Please Specify
Specify Other Area of Help
*
What kind of setting would you prefer?
*
1 on 1
Small Group - Same grade level or specific skill
Sibling Group
No Preference
Any information you would like to share about your child. (special needs, diagnosis, etc)
Submit
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