A+ Tutoring and Test Prep

PARENT RESOURCES

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A+ TUTORING AND TEST PREP, LLC
Turning Student Challenges into Conquests

(602) 703-3901 or (602) 413-2393 • Info@TutorArizona.com

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A+ CLIENT OPENING EVALUATION

SECTION A – DEMOGRAPHIC INFO
Student Firstname:
Student Lastname:
DOB:
Subject(s):
School Grade (ie 10th ):
Mom:
Dad:
Street Address:
City:
Zip:
Home Phone:
Home Fax:
Mom Work Phone:
Mom Cell Phone:
Dad Work Phone:
Dad Cell Phone:
Student Email:
Mom Email:
Dad Email:

SECTION B - BEHAVIORAL INFO
Receptive to tutoring?
Yes No Uncertain
Tutor Gender Preference?
M F Tutor Name
Interests/Activities:
Student Goal(s):
Incentive(s):
Parent Goal(s):

SECTION C – COMMUNICATION INFO
Teacher Conference set up?
Yes No When ?
By what means is the parents and the school communicating?
WEB EMAIL PHONE PROGRESS REPOSRT
How Often? :

SECTION D - ACADEMIC PERFORMANCE INFO

Beginning Grade or % :

Last Class in Subject :

Letter Grade:

When?:

Related Strengths:

Related Challenges:
(ie ADD, ADHD, Dyslexia)

504/IEP Disability Area(s) :

Medical Conditions :

Medications:

SECTION E - CHOOSE SERVICE

	CertifiedTeacher		NonCertified Teacher
Single Session	$69		$59
6 Packs	$396		$336
10 Packs	$630		$530