Sample form. Try it out: nothing you enter is sent or saved.
Online tutoring intake
Step
1
of 4
Student
Student name
*
Date of birth
Grade
*
Select…
Kindergarten
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
College / Adult
School
Next
Parent or guardian
Parent or guardian name
*
Email
*
Phone
Back
Next
Learning goals
Subjects
*
Math
English
Science
French
History
Coding
Other
What would you like to achieve?
*
For example: raise a grade, prepare for an exam, build confidence.
Anything we should know about how the student learns best?
Back
Next
Online setup
Time zone
*
Select…
Eastern
Central
Mountain
Pacific
Alaska
Hawaii
Other
Device for lessons
*
Laptop or computer
Tablet
Phone
Reliable internet at home?
Yes
No
Preferred video platform
Zoom
Google Meet
Microsoft Teams
No preference
Preferred days
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Preferred time of day
*
Morning
Afternoon
Evening
Back
Submit
Leave this empty
✓
Thank you! We've received your details and will be in touch soon to plan the first lesson.