Returning Student A-HTS®Tutoring Request Form

Student Name:*

First Last

Parent Name:*

First Last

Parent Cell:*

Email:*

Address:*

Zip Code*

School:*

Grade Level:*

Year of High School Graduation:*

Preferred Method of Tutoring Delivery*

In-Person
Virtual Tutoring in our Online Classroom
Either

Type of Tutoring Desired (Can Select More Than One)*

Academic Tutoring (after school hours)
Remote Learning Support (during school day to assist with virtual learning)
Test Preparation (ISEE Exam)
Test Preparation (ACT, SAT or other)
College Counseling
Diagnostic and Skills Assessment

Note: All ISEE students must enroll in our online test preparation program.*

I agree to the $99 online program fee.

All A-HTS ISEE students MUST have an account with our online ISEE program at a cost of $99 per year.

Desired Total Hours Per Week*

Superintendent Level: 10 hours
Principal Level: 5 hours
Teacher Level: 3 hours
Other - please call us to customize an option for you

Will Tutoring be Part of a Group or Learning Pod?*

Yes
No

Please List the Names of the Other Parent(s) in the Group*

Subjects for Tutoring:*

Describe the Challenges Your Student Faced While Remote Learning:*

Please list some academic goals for your student*

Are You Interested in Your Student Taking a Skills Assessment ($99 fee per student)?*

Yes
No

Does your student already have an Edmentum/Exact Path Account?*

Yes
No

Ideal Days/Times For Sessions:*

Days	Times	Duration

Total Open Days (outside above times)*

Days	Times	Duration

Include any activities to take into account when scheduling, if applicable. Please include practice schedule: (sports, play rehearsals, etc.)

Desired Start Date:*

Tutor Gender Preference*

Female Only
Male Only
Tutor Gender Preference

Preferred Tutor (Name):

Tutoring Personality Preference*

Number of Sessions per week*

Top 3 Tips to Teach Your Student Effectively:*

1)	2)	3)

If requesting test preparation (ISEE/ACT/SAT), please upload any previous test scores here

Drop files here or

Official Test Date(s)

Special Notes (if any):

Returning Student A-HTS®Tutoring Request Form

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