Consultation Form
Welcome!
Kindly complete the following form to help me prepare for your complimentary consultation. I am excited to meet you!
Miss Dori
PARENT / GUARDIAN INFORMATION:
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How did you hear about Miss Dori Tutoring?
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Referral
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Referred by (if applicable)
STUDENT CONTACT INFORMATION:
Student's First Name
Last Name
Student's Gmail / Personal Email
Student's School Email
Student's Cell (Required for Lesson Reminders)
Birth Date
GOALS
Current Mark
Desired Mark %
IEPs, Accommodations (extra time), Learning Differences, Gifted, etc.
Has the student worked with a tutor in the past? Please describe.
Goals and Other Info
SCHOOL & ACADEMIC INFORMATION
Type of School
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Public
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Catholic
Charter
Homeschool
Online
College
University
Other
French or English School? (Canada)
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English
French
French Immersion
Academic Year (eg. Grade 9)
Subjects (for tutoring)
Accounting
ACT / SAT
Advanced Functions (Gr 12)
Algebra 1
Algebra 2
AP Calculus AB
AP Calculus BC
AP Computer Science
AP PreCalculus
AP Statistics
Biology
Calculus
CFA
Chemistry
College/University Linear Algebra
Competition Math / Enrichment
Computer Programming
CS: C / C++
CS: Java
CS: Python
CSC
Data Management (Ontario)
Economics
Elementary Math (K-6)
English / Essay Writing
ESL
Finance
French
Functions & Applications (Gr 11)
Functions (Gr 11)
GED
General Homework Help
Geometry
High-School Math (9-10)
Middle-School Math (7-8)
Physics
PreCalculus
Reading (4-6)
Reading (K-3)
Science
Is Math Semestered or a Full-Year Course?
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