Student Intake Form | Elementalschildren

Basic Information

Student first name

Student last name

Email

Address

Grade Level

School

School District

These questions help us understand how you think when something is new or tricky.

1. When you see a problem you don’t understand right away, what do you usually do?

I wait for help

I try, but I’m not sure how to break it down

I guess and move on

I try to figure it out step by step

2. When something feels difficult, how do you usually feel?

These questions help us see how well you understand something new and how confident you feel using it.

3. When you learn something new, which feels most like you?

I understand only after someone explains it

I understand a little, but get confused on my own

I understand and can try it myself

I understand and can explain it to someone else

4. A number is between 10 and 20. It is even. It is greater than 12 and less than 18. What could the number be?

How did you figure it out?

We review each response carefully before assigning sessions.

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