Initial Consultation Screening

Please provide answers to the prompts below in order to help your academic coach/tutor better understand your needs and provide a tailored tutoring experience.

First name & Last name

Child First & Last Name (If Applicable)

Tutee/Client Date of Birth

Phone Number

Address

Email

Child's Email (If Applicable)

Which services are you interested in learning more about? (Select all that apply)

Test Score/Grade

Please provide the overall grade or highest test score achieved, for which you seek services

Math Test Score/Grade

Please provide the overall grade or highest test score achieved, for which you seek services

Reading & English Test Score/Grade

Please provide the overall grade or highest test score achieved, for which you seek services

Approximately what day would you like to begin?

Are you interested in virtual or in-person tutoring? (select all that apply)

Virtual

In-Person

For in-person tutoring, which location(s) can you meet your tutor?(skip if you will be meeting virtually)

*may entail a surcharge for locations outside a 10 mile radius of Fort Lauderdale

Please include any additional information you would like us to know