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Primary Contact

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Secondary Contact information (optional)

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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

Is the student an (ESL) English as a Second Language Learner?

Has the student been identified with a learning exceptionality?

If the student has been identified select the exceptionality(s) that apply

Autism Spectrum Disorder Behaviour Developmental Disability Giftedness Language and Speech Impairment Blind and Low Vision Learning Disability Mild Intellectual Disability Physical Other

An Individual Education Plan (IEP)?

A Safety Plan

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

Session Details

Number of sessions per week:

Session Length (hours):

Preferred day/s and time

Monday

Select time (format xx:xx AM or xx:xx PM).

Tuesday

Select time (format xx:xx AM or xx:xx PM).

Wednesday

Select time (format xx:xx AM or xx:xx PM).

Thursday

Select time (format xx:xx AM or xx:xx PM).

Friday

Select time (format xx:xx AM or xx:xx PM).

Saturday

Select time (format xx:xx AM or xx:xx PM).

Sunday

Select time (format xx:xx AM or xx:xx PM).

Flexible

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

Academic Goals

What are the primary reasons for requesting tutoring?.

Develop a better understanding of concepts to meet curriculum expectations Enrich subject material beyond present grade level Maintain acquired academic skills over the summer Boost self-esteem and gain confidence in the subject area Improve Test taking strategies Improve study habits such as organization, planning practice times, note taking, and time management Enhance present understanding of concepts to exceed curriculum expectations Prepare for a test/exam Improve academic performance/grades in the subject Improve attitude towards learning and school Receive support with homework and study responsibilities

Add additional goals not listed

Would you be interested in tutors assigning homework and practice questions at the end of each session?

Would you be interested in tutors providing testing and assessment opportunities?

Things you are very good at in the subject(s) you require tutoring.

List 2 things you struggle with in this subject.

What unit and/or topics are you currently learning?:

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?

On line course tools Study/resource guide Teacher notes none of the above Course Pack Textbook Homework sheets

Select the skill or habit that needs improvement.

Responsibility completes and submits class work, homework, and assignments according to agreed upon timelines Collaboration responds positively to the ideas, opinions, values, and traditions of others Initiative acts upon new ideas and opportunities for learning
Independent Work follows instructions with minimal supervision Organization establishes priorities then creates and follows a plan to complete work and tasks Self-Regulation sets his/her individual goals and monitors progress towards achieving them

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:

Card number:

Cardholder Name:

CVV:

Exp date:

Is the student an (ESL) English as a Second Language Learner?

Has the student been identified with a learning exceptionality?

If the student has been identified select the exceptionality(s) that apply

Autism Spectrum Disorder Behaviour Developmental Disability Giftedness Language and Speech Impairment Blind and Low Vision Learning Disability Mild Intellectual Disability Physical Other

An Individual Education Plan (IEP)?

A Safety Plan

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

Session Details

Number of sessions per week:

Session Length (hours):

Preferred day/s and time

Monday

Select time (format xx:xx AM or xx:xx PM).

Tuesday

Select time (format xx:xx AM or xx:xx PM).

Wednesday

Select time (format xx:xx AM or xx:xx PM).

Thursday

Select time (format xx:xx AM or xx:xx PM).

Friday

Select time (format xx:xx AM or xx:xx PM).

Saturday

Select time (format xx:xx AM or xx:xx PM).

Sunday

Select time (format xx:xx AM or xx:xx PM).

Flexible

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

Academic Goals

What are the primary reasons for requesting tutoring?.

Add additional goals not listed

Would you be interested in tutors assigning homework and practice questions at the end of each session?

Would you be interested in tutors providing testing and assessment opportunities?

Things you are very good at in the subject(s) you require tutoring.

List 2 things you struggle with in this subject.

What unit and/or topics are you currently learning?:

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?

On line course tools Study/resource guide Teacher notes none of the above Course Pack Textbook Homework sheets

Select 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:

Card number:

Cardholder Name:

CVV:

Exp date:

4
Academic Goals (optional)

What are the primary reasons for requesting tutoring?

Develop a better understanding of concepts to meet curriculum expectations Enhance present understanding of concepts to exceed curriculum expectations Enrich subject material beyond present grade level Prepare for a test/exam Maintain acquired academic skills over the summer Improve academic performance/grades in the subject Boost self-esteem and gain confidence in the subject area Improve attitude towards learning and school Improve Test taking strategies Receive support with homework and study responsibilities Improve study habits such as organization, planning practice times, note taking, and time management

Add additional goals not listed.

Would you be interested in tutors assigning homework and practice questions at the end of each session?

Would you be interested in tutors providing testing and assessment opportunities?

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?

On line course tools Course Pack Study/resource guide Textbook Teacher notes Homework sheets none of the above

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

Responsibility completes and submits class work, homework, and assignments according to agreed upon timelines Independent Work follows instructions with minimal supervision Collaboration responds positively to the ideas, opinions, values, and traditions of others Organization establishes priorities then creates and follows a plan to complete work and tasks Initiative acts upon new ideas and opportunities for learning Self-Regulation sets his/her individual goals and monitors progress towards achieving them

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.

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1 Primary Contact

2 Secondary Contact information (optional)

3 Student Information

4 Academic Goals (optional)

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Primary Contact

2
Secondary Contact information (optional)

3
Student Information

4
Academic Goals (optional)