Summer School Form - One On One Tutoring Service

info@oneononetutor.com
215 842-0400
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Summer School Form

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Summer School Form

Summer School Questionnaire

The Below Questionnaire will allow the One On One Tutoring Service to recommend a learning program and workbooks that will address your child’s academic needs. Please answer all questions.

Parent Name *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Phone

Student's Name *

Student's Date of Birth *

Student's Age *

Student's Grade *

Student's School

Area of weakness? Reading, Writing, Math, other *

Reading
Writing
Math
Other

What age or grade was this problem first identified?

Was an intervention implemented when problem area was first identified?

Yes
No

Does student have an Individualized Education Plan (IEP)?

Yes
No

How often has student transferred schools (for grades k-12)?

Selected Value: 0

Would you prefer our online program or attend sessions at our learning center location?

Learning Center
Online

Would you like to schedule an online assessment or at our learning center?

Online Assessment
In-person

Please select an assessment:

Reading
Math
Both

One On One Tutoring Service was established by a classroom teacher who recognized the dire need for additional instruction outside the normal school setting.

Contact Us

7047 Germantown Avenue Suite 204, Philadelphia, PA 19119.

215 842-0400

info@oneononetutor.com

www.oneononetutor.com

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