Parent Intake Form | Elementalschildren

Basic Information

First name

Last name

Email

Phone

Address

Child's first name

Child's last name

Grade Level

School

School District

This section helps us understand how your child currently approaches learning—especially when faced with difficulty.

1. How would you describe your child’s current academic level?

Below grade level

At grade level

Above grade level

Not sure

2. When your child encounters something they don’t immediately understand, what do they do?

3. What would you like to see change over the next 3–6 months?

4. Has your child worked with tutors or programs before?

Yes

No

Please let us know what worked well and what didn't work well in those tutor programs.

Please let us know you're child's preferred days/times to attend our program.

We review each response carefully before assigning sessions.

You will hear back within 24–48 hours with next steps.