Please complete as much of the form as possible before submitting. Click on each number to expand. We look forward hearing from you.

1
Primary Contact

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2
Secondary Contact information (optional)

Enter the information in the boxes provided

3
Student Information

This is a comprehensive form, please complete with as many specific details as necessary so that a suitable tutor match can be arranged.



Next information student. Student № . Delete student info

List and/or describe other diagnosed conditions that may have an impact on the student’s learning in the box below.

Session Details

Preferred day/s and time

Please enter your preferred start date below

Student’s Learning Style Please select your students learning style(s). Descriptions are provided to assist you

VISUAL LEARNERS learn best by: Using charts, notes, videos, and flash cards Visualizing or picturing words and concepts Writing out everything when reviewing
AUDITORY LEARNERS learn best by: Listening to lectures and tapes Summarizing readings and then reciting the summary out loud Talking to others when reviewing
KINESTHETIC LEARNERS learn best by: Making study sheets and writing facts out several times Associating class material with real-world things or occurrences Role playing
List and/or describe other diagnosed conditions that may have an impact on the student’s learning in the box below.

Session Details

Preferred day/s and time

Please enter your preferred start date below

Student’s Learning Style Please select your students learning style(s). Descriptions are provided to assist you

VISUAL LEARNERS learn best by: Using charts, notes, videos, and flash cards Visualizing or picturing words and concepts Writing out everything when reviewing
AUDITORY LEARNERS learn best by: Listening to lectures and tapes Summarizing readings and then reciting the summary out loud Talking to others when reviewing
KINESTHETIC LEARNERS learn best by: Making study sheets and writing facts out several times Associating class material with real-world things or occurrences Role playing

4
Academic Goals (optional)

What are the primary reasons for requesting tutoring?

Add additional goals not listed.
List 2 things you are very good at in the subject(s) you require tutoring.
List 2 things you struggle with in this subject.
List two things you need help with in the first session. (Be as specific as possible)

Select the resources that are available to you for this subject?

Learning Skills and Work HabitsSelect the skill or habit that needs improvement.

Please provide any additional information that will assist in meeting the learning needs of the student and making the tutoring experience enjoyable.
Please include student interests and hobbies.