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Student Enrollment Form
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* Indicates required question
Email
*
Your email
Enter Student Name [First Last]
*
Your answer
Student Grade level
*
Kindergarten-3rd Grade
4th-6th Grade
7th-9th Grade
Student's School
*
Your answer
Parent(s)/ Guardian(s) Name
*
Your answer
Primary Address
*
Your answer
Phone Number
*
Your answer
Please list the areas of difficulty for which you are seeking support:
*
Reading/Writing
Math
Science
English
Social Studies
Foreign Language
SAT Prep
Critical Thinking/Social skills
Other:
Required
Please list specific areas of difficulty from the list above.
*
Your answer
Does your student have any individualized Education Programs (IEP) or learning disabilities? Please list below or state "N/A"
*
Your answer
Are you interested in our:
*
Day school Academy
Home school/Virtual Learning Program
After-school/Tutoring
IEP Services
Youth Coaching Program
Other:
Required
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