Initial Consultation Form

Please take a moment to fill out the following form. This information will help students, parents, and the tutor to understand the goals and objectives that you are trying to achieve.

Date*
MM slash DD slash YYYY
Who took the call?*
Name of caller/internet inquiry (Parent/Guardian)*
Parent Phone*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email
Student's Name*
Phone
Student Email
School
Age
Year of Graduation*
How did you hear about FOL?
Students most recent grades or report card
Student is interested in:*
- Test prep
- Math tutoring
- Science tutoring
- Reading tutoring
- English tutoring
- Writing tutoring
- Study skills
Type of test prep
- ACT
- SAT
- PSAT
Student wants SAT
- Private Tutoring
Student wants PSAT
- Private Tutoring
Student wants ACT
- Private Tutoring
- ACT Prep Class
ACT Prep Class student is interested in
- ACT Jump Start Class - June 6th - $100
- Advanced ACT Class - Starts June 7th, 2021 ($750)
- Fundamentals ACT Class - Starts June 7th, 2021 ($395)
- Fundamentals ACT Class - Starts July 5th, 2021 ($395)
- ACT Jump Start Class - July 16th - $100
Date of Test:
MM slash DD slash YYYY
Goal Score
Have they taken the test before?
- Yes
- No
Prior tests date(s)
Prior ACT/SAT tests score break down
What are the composite scores and each individual subtest score from each tests you have taken?
What type of math tutoring are you interested in receiving?
- Pre-algebra
- Algebra
- Geometry
- Pre-Calculus
- Calculus
- Statistics
- Other
What type of science tutoring are you interested in receiving?
- Biology
- Chemistry
- Physics
- Other
Educators that this student will see:
- Dr. Chippendale
- Mr. Simmons
- Dr. Moss
- Mr. Scharenborg
- Mr. Burns
- Mr. Larkin
- Mr. Adams
- Mrs. Barkume
Type of appointment set:
- Recurring
- As needed
Have they been here before?
Additional Information