New Student Inquiry

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Student Name *

First

Last

Guardian Name *

First

Last

Email *

Are you seeking in-person or virtual tutoring? *— Select Choice —in-personvirtual

Student Age *

Student Grade *

Which curricula are you interested in?Barton Reading and SpellingFoundation in Sounds

Has your student been diagnosed with dyslexia?yesno

Does your student have any other pertinent diagnoses like ADHD, autism, dysgraphia, etc?yesno

If yes, please list and describe.

Has your student ever received private OG tutoring?yesno

If yes, where and when? Why did you stop?

Are virtual diagnoses

Are you able to commit to at least one year? *— Select Choice —yesno

Please include any other helpful information.

Submit

If you have not received a response within seven days of submitting this form, please contact me directly at

alyssa.barton.tutor@outlook.com

Thank you!