Private Tutoring Application

Name of student:____________________________________________________
Grade of student: _____
Students school:_______________________
Advance or
Help (circle which you would like to do, does your
child need help? or do you want to advance their knowledge?)
Which subject(s) would you like to focus on:
_____________________________________________________________________
Parent Name:_______________________________________________________
Parent Email:________________________ Parent Phone: ________________
Days of the week preferred: ________________________________________
Times preferred:____________________________________________________
What date would you like to start:___________________________________
What date would you like to end:____________________________________
What dates are you not available if applicable:
_____________________________________________________________________
_____________________________________________________________________
Which sessions would you prefer:
*rates are adjustable*
1 hour: $15

or

2 hours: $20

Group session

or

Single Student

Please email me this application or the information if you cannot

send the pdf or return to 140 Sunstone Dr Cary, NC 27519
If you have any other questions or concerns feel free to email me :
privatetutoring140@gmail.com
*** Cornerstone residents*** If you would wish to return the
application to my address I am in the neighborhood across the street
from the Cornerstone main entrance (Stone Creek) and the second
house on the left from the main entrance.