2017-2018 Specialized Tutoring Program Enrollment Form Parent/Guardian’s Information Name: Telephone Number: Alternate Contact: Telephone Number: Student’s Information Name: Date of Birth: Age: Grade: Subjects: Preferred Schedule Please check appropriate boxes based on amount of session preferred and desired schedule. 3 times a week $35.00 an hr. Monthly Payments $420 for 12 sessions 2 a week $40.00 an hr. Monthly Payments $320 for 8 sessions 1 time a week $45.00 an hr. Monthly Payments $180 for 4 sessions Monday Tuesday Wednesday Thursday Friday 3:30 4:30 – 4:30 5:30 – 5:30 6:30 – Saturday Mornings Saturday Afternoons 9:00 10:00 12:30 1:30 – – 10:00 11:00 1:30 2:30 – – 11:00 12:00 2:30 3:30 – –
2017-2018 Specialized Tutoring Program Enrollment Form Parent/Guardian’s Information Name: Telephone Number: Alternate Contact: Telephone Number: Student’s Information Name: Date of Birth: Age: Grade: Subjects: Preferred Schedule Please check appropriate boxes based on amount of session preferred and desired schedule. 3 times a week $35.00 an hr. Monthly Payments $420 for 12 sessions 2 a week $40.00 an hr. Monthly Payments $320 for 8 sessions 1 time a week $45.00 an hr. Monthly Payments $180 for 4 sessions Monday Tuesday Wednesday Thursday Friday 3:30 – 4:30 4:30 – 5:30 5:30 – 6:30 Saturday Mornings Saturday Afternoons 9:00 – 10:00 12:30 – 1:30 10:00 – 11:00 1:30 – 2:30 11:00 – 12:00 2:30 – 3:30
2017-2018_enrollment.docx