You can access our Tutor Request form in Word format by
clicking here, and sending it as an attachment to Tutors2000@aol.com.

Or, please copy and paste the form below into an email and send it to Tutors2000@aol.com.

Simply Tutoring Student Intake Sheet 

Student’s name: 

Parent’s name: 

Home phone:                  
Work phone:
Cell phone:

Address:                     

Email:

Current grade:         Age:                                School:

1.  Subject(s) of difficulty:  

Subject(s):

Why do YOU think your child is struggling? 

What are your expectations for tutoring? 

2.  Best learning style?  (auditory - visual - tactile/kinesthetic -  not sure)    

Learning disability/challenge?            
Student interests/personality?

3.  Type of tutor preferred?   (male or female or open?)

____Honors-level H.S. student                        
____College student         
____Degreed adult                                         
____Certified teacher  
____Open

Preferred price range?  _______($28 to $55 per hour)   ____open 

Important qualities of the tutor?

4.  Preferred location of tutoring?  ___your home  ____tutor’s home  ____neutral place ____open

5.  Scheduling preferences? (Days/times)

Number of hours per week?                                                               
Available to begin? 

6.  Anything else that will help us make a good match? 

How did you hear about us?

Today’s date?