Please fill out the information for your students academic file.

Once we receive it we will send out a tentative schedule.

**Please fill out all fields marked with an * for application to be submitted

Test Prep Subject: *

Parent Information

First Name *

Last Name *

Phone *

Email *

Address *

City *

State *

Postal code *

Mother Occupation/Place of Employment *

Father Occupation/Place of Employment *

Student Information

Student First Name *

Student Last Name *

Student Email *

Student Email Address MUST be different than parents' Email Address

Student Phone *

Student Date of Birth *

Current Grade *

School Attended *

Scheduled Test Date

Services & Accommodations

Are you interested in comprehensive college advising and application services for your child? *

Yes

Are you interested in comprehensive academic tutoring across all subjects for your child? *

Yes

Are you interested in career mapping and career services for your child (i.e resume building, applications, career testing)? *

Yes

What is your preferred tutoring format? *

Virtual (1-on-1)

In-person (1-on-1)*

Hybrid Format (1-on-1 Virtual & In-person combined)

No Preference / Flexible (Whatever format is available)

*In Person (Available at select office locations- Miami, Wellington/West Palm Beach, Aventura/North Miami)

Does your student require extended time or testing accommodations for standardized test preparation?

Yes

Have you already completed a formal psychoeducational evaluation for your child?

Yes

Would you like more information about obtaining a psychoeducational evaluation and accommodation diagnostic services?

Yes, please contact me with details

No, not at this time

Classroom Behavior

Assignment completion *

Problematic

Average

Above Average

Organizational skills *

Problematic

Average

Above Average

Following directions/rules *

Problematic

Average

Above Average

Relationship with peers *

Problematic

Average

Above Average

Disrupting class *

Problematic

Average

Above Average

Tentative Schedule:

Monday - Friday: 2pm-10pm

Saturday: 8am-5pm

Sunday: 8am -5pm

options available on Sat/Sun for morning, afternoon and evening

What days are best for your session? *

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

What is your best availability for sessions? *

How did you hear about us? *

Additional Information