Let’s work together. Together we can achieve great things! Tutoring Intake Form What is your name? What is your child's name? Is your child currently in public school, homeschool, or private school? What grade is your child in? Is your child currently receiving or have they ever received any reading intervention? If yes, please explain. Have any of your child's past teachers expressed specific reading concerns (i.e. a specific concept or skill - long vowels, blending, comprehension, etc.)? What concerns do you have regarding your child's reading? What are your child's strengths and interests? What do you hope your child will gain from tutoring? Do afterschool sessions work for you? What days and times are best? If in person tutoring cannot be accomodated, would you be open to an online tutoring program curated by me? Where are you located? (Town, State) Preferred way to contact you? (email, text, phone call) Email * Phone (###) ### #### Thank you for the information, I will be in contact as soon as possible!
