Consultation Form
Welcome!
I am excited to begin working together. Kindly complete the following form to help me prepare for our first meeting.
If you'd like to learn more about me, my approach, or tutoring rates in the meantime, feel free to visit my website: MissDoriTutoring.com
If you're adding a second child, scroll to the bottom and click the green button that says, "Add an additional student".
I can't wait to meet you!
Miss Dori
PARENT / GUARDIAN INFORMATION:
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Last Name
Email
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Cell Phone
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Iraq
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Monaco
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Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
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Postal / ZIP Code
How did you hear about Miss Dori Tutoring?
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Other
Referred by (if applicable)
STUDENT CONTACT INFORMATION:
Student's First Name
Last Name
Birth Date
Student's Cell (Required for Lesson Reminders)
Student's Gmail
Student's School Email
GOALS
Subjects (for tutoring)
Accounting
ACT / SAT
Advanced Functions (Gr 12)
Algebra 1
Algebra 2
Algebra 2 - Honours
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
Spirit of Math
SSAT - Elementary
SSAT - Middle
SSAT - Upper
Current Mark
Desired Mark %
IEP/Accommodations (extra time) and Learning Differences (Gifted, ADHD, etc.)
Has the student worked with a tutor in the past? Please describe.
Preferred Lesson Time(s) / Day(s)
Goals and Other Info
SCHOOL & ACADEMIC INFORMATION
School Name (or Homeschooled)
Academic Year (eg. Grade 9)
Type of School
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Charter
Homeschool
Online
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Is Math Semestered or a Full-Year Course?
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First Semester Only
Second Semester Only
Full Year
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SCHOOL PLATFORM / LINKS
Textbook Name / Publisher / ISBN
Textbook Link
School Platform
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Google Classroom
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Schoology
Canvas
Moodle
My Math Lab
Veracross
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School Platform Link
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