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Register for Tutoring Services Today!

PARENT SIGNUP FORM for STUDENT TUTORING

*Please complete a seperate form for each child.

Student's First and Last name

Parent's First and Last name

Phone Number

Parent Email Address

Student Email (if different from parents)

Student's AGE, GRADE LEVEL and CURENT SCHOOL

Student's Home Adress, City, and State

Course giving student the most difficulty (Ex: Algebra, 8th grade Language Arts, etc.).

Does the student have an IEP? *

Yes

No

What are your best DAY(s) and TIME(s) for hourly tutoring?

Thanks for submitting!

JIT TUTOR SIGNUP FORM

First Name

Last Name

Phone

Email

Highest Level of Education

Teaching Experience *

Yes

No

Special Needs Experience (IEP) *

Yes

No

Zoom Accessibility: *

Yes

No

Date

ADULT STUDENT SIGNUP FORM

First Name

Last Name

Phone Number

Email

High school (*if appropriate)

University (*if appropriate)

What are you currently pursuing? *

GED

College

Grad School

Doctoral Studies

What are your specific needs?

Thanks for submitting!

Specialized Tutoring Opportunities

wrbaskerville@gmail.com

DONATE

wrbaskerville@gmail.com

: $RuthBaskerville

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