Student's Name
Parent's Name
 
Address
 
   
City
 
State
 
Zip
 
Daytime Phone
 
Evening Phone
 
Email Address
 

Year in School
 
Name of School
 
How did you hear about us?
 
 

PLEASE SELECT A TUTORING PROGAM:


Subject Tutoring
 

Test Preparation

$45 per hour*

 
*This is a special rate for new clients who sign up for tutoring after April 1, 2012. Our usual rate for subject tutoring is $55/hr.
 
Please specify subject:
 
     

$55 per hour*

 
*This is a special rate for new clients who sign up for tutoring after April 1, 2012. Our usual rate for test prep is $65/hr.
   
Please specify test:

Please use the space below to provide any additional details regarding your specific tutoring needs
and/or for any other questions or comments.