Student Contract Form Step 1 of 2 50% Parent/Guardian Name* Address* Parent/Guardian's Phone*Parent/Guardian Email* Student's Name* Student's PhoneStudent Email School* Year of Graduation* What type of private tutoring are you looking for?* Test prep Subject-based tutoring Type of test prep* ACT PSAT SAT Test Date:* MM slash DD slash YYYY Educators available for private test prep tutoring* Dr. Ene-Kaja Chippendale - English/Reading/Writing/Verbal ($110.00/hour) Ms. Samantha Edmonds - English/Reading/Writing ($90.00/hour) Dr. Gary Moss - - Math/Science - ($110.00/hour) Mr. Justin Burns - - Math/Science - ($90.00/hour) Mr. Tom Sharenborg - Math/Science - ($90.00/hour) Mr. Tim Larkin - - Math/Science - ($90.00/hour) Ms. Sarah Laster - Chemistry - ($80.00/hour) Type of private subject-based tutoring* English tutoring Reading tutoring Math tutoring Science tutoring Study Skills Educators available for private subject-based tutoring* Dr. Ene-Kaja Chippendale - English and Reading ($110.00/hour) Ms. Samantha Edmonds ($80.00/hour) Mr. Justin Burns - H.S. and College Math - ($85-90.00/hour) Mr. Tim Larkin - Math/Science - ($80.00-90.00/hour) Mr. Tom Sharenborg - H.S. and College Math/Science - ($90.00/hour) Mrs. Shanna Barkume - Chemistry ($80.00/hour) Ms. Sarah Laster - Chemistry ($80.00/hour) Prices are dependent on whether the student is in high school or college.ACT Prep Materials: Option 1) $85 Packet of materials includes two student workbooks (English/Reading and Math/Science), supplemental worksheets, 3ACT practice tests, and an official ACT Test Buddy Watch to optimize pacing. The watch is programmed for the subtests on the ACT. Students with extended time only need the $50 materials package. Materials can be picked up at Focus or mailed for an additional $19. Option 2) Materials can be downloaded in 3 ways: 1- Complete packet for English/Reading, Math/Science, practice sheets, and 3 ACT tests for $40 at http://www.focusonlearningcenter.com/ps/all-act-prep-materials/. 2- English/Reading workbook, practice sheets, and 3 ACT tests for $25 at http://www.focusonlearningcenter.com/ps/act-prep-english-and-reading-materials. 3-Math/Science workbook, practice sheets, and 3 ACT tests for $25 at http://www.focusonlearningcenter.com/ps/act-prep-math-and-science-materials. Order the ACT Test Buddy watch for $35 on Amazon.com.Type of appointment set: Recurring As needed PAYMENT: Payment is due BY or ON the day of service. 1) Clients set their own appointments on Calendly and prepay using PayPal or VISA, MASTERCARD, DISCOVER, or AMERICAN EXPRESS.* 2) Clients who prefer to pay by check on day of service call 573-239-4074 and leave a message and we will schedule your appointment through the office. Any collection fees/legal costs occurring from nonpayment will be the client’s responsibility. IF PAYMENTS FALL MORE THAN 2 SESSIONS AN ARREARS, WE RESERVE THE RIGHT TO WITH HOLD FURTHER APPOINTMENTS UNTIL AN ARRANGEMENT FOR PAYMENT HAS BEEN MADE. *Cancellations made 24 hrs. prior to the appointment will be carried over to the next session. Late cancellations will be charged a full rate. CANCELLATIONS AND MISSED APPOINTMENTS: Cancellations, except for illness or emergencies, must be made 24 hours in advance or FULL rates will apply. Missed appointments (NO SHOWS) will also be charged FULL rates. Please leave a message for a call-back a 573-239-4074.I have read and understand these policies, and agree to abide by these terms and conditions* I agree Name* First Last Initials* Date* MM slash DD slash YYYY Δ
