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Student Enrollment Form

Student's Name? *

How did you hear about us?

Grade Level? *

What Math Subject is the student currently taking? *

Lower Grade Level Math

Pre-Algebra

Algebra I

Geometry

Algebra II

Pre-Calculus

Calculus (AB or BC)

SAT, ACT, and other Testing Mathematics

College Level Math

Other:

Previous School Attended?

Parent/Guardian's Name? (if applicable)

What plan are you interested in? *

Once a Week: ONE SCHEDULED 90-minute session per week during the 4-week cycle (4 sessions total).

Twice a Week: TWO SCHEDULED 90-minute sessions per week (8 sessions total).

Three Times a Week: THREE SCHEDULED 90-minute sessions per week (12 sessions total).

Walk In: ONE 90-minute session, as needed.

Unsure — use diagnostic test to determine schedule.

Preferred Day

Preferred Time

Parent/Guardian Contact Number? *

Parent/Guardian Contact Email? *

Preferred Contact Method? *

Message

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