Student's Name Student's Age
Current School Attending
Student Grade Average Academic Grade Level.
Most Difficult Subject Matter
Most Liked Subject Matter
Is your child assigned a school counselor with an Individual Education Plan (IEP)?
Has your child ever had problems with behavior or learning in school?
Parent Name
Address
Phone Number
Do you want your child to receive:
FREE Private School Education?FREE Afterschool Tutoring?How soon would you like your child to start?
Would you accept a scholarship for your child?
Appointment Date:
Appointment Time:
