Student Registration Form

The registration form contains detailed questions about the student’s academic history and character profile, the answers to which will allow The Learning Curve to select the tutor whose background, teaching style and personality provide the best possible match. In light of this, please be as specific and thorough as possible when filling it out.

IMPORTANT INSTRUCTIONS ABOUT THIS FORM:
Do NOT hit “Enter” or “Return” to move between fields; doing so will result in your sending an incomplete form. Instead, please use the “Tab” key or click each field separately.


 

Name of the person completing this form

E-mail address of the person completing this form

A) Student information

Name (First and Last)

MaleFemale
Age Date of Birth

School

Grade

Student's E-mail Address (if applicable)

Student's Cell Number (if applicable)

B) Parent/Guardian Information

Name (First and Last)

Relationship to Student

Mailing Address



Nearest Main Intersection (2 streets)

E-mail Address

Phone Numbers




Billing Preference by e-mailby Canada Post

C) Tutoring Requirements and Scheduling

1. Please select the subject(s) in which the student requires tutoring by checking the appropriate boxes. Beside each selection specify the course, where applicable. For example, Mathematics - grade 12 calculus and vectors, Science - grade 11 physics, etc. Also indicate the student’s current average for each selected subject, or the student’s final grade from the previous year.
Mathematics:
Science:
English:
French:
International Languages:
Business Studies:
Canadian and World Studies:
Social Sciences and Humanities:
English as a Second Language:
Others:
Standardized Testing (SAT/PSAT/SSAT, etc.):

2. By checking the appropriate boxes below, please identify any specific skill sets that should also be addressed by a tutor.
Organizational skills
Time management skills
Note-taking skills
Test/exam prep skills
Test/exam writing strategies
Memorization techniques
Vocabulary-building
Reading and comprehension
Thesis development and essay writing
Fundamental math skills and number sense
Problem solving and analytical skills
Other skills:

3. How often does the student require tutoring?

4. What type of tutoring schedule would the student prefer?

5. Where should the tutoring sessions take place?

In consideration of the fact that some tutors may have certain allergies or sensitivities, please provide a description of any household pets, and indicate whether your home is a smoking or smoke-free environment.

6. Please check off all the possible days of the week when the student would be available for tutoring. Beside each selection, indicate more specifically what time(s) of day would be most optimal.
Monday -
Tuesday -
Wednesday -
Thursday -
Friday -
Saturday -
Sunday -

7. When would you like this tutoring campaign to get underway?

D) Academic Profile

1. Please summarize the main reasons for this tutoring request.

2. Has the student been:
i) identified as gifted?
YesNo
ii) diagnosed with any learning disabilities?
YesNo
If yes (to part ii), please provide details regarding the nature of the disability(ies), coping strategies, prescribed medication and any other pertinent information.

3. If applicable, what are some of the factors (aside from any described in question 2 above) affecting the student's performance in the subjects that have been selected for tutoring? For example, poor relationship with the teacher, the class is moving too fast, busy personal schedule, etc.

4. Describe the student's academic history, especially as it pertains to the subjects that have been selected for tutoring. In particular, please make mention of the student's former schools, trends in his/her average marks over the years, past awards of merit, etc.

5. For each subject requiring tutoring, please identify the specific topics that are (or have historically been) giving the student some trouble and/or the current unit being studied at school. For example, fractions (math), Shakespeare (English), the mole (chemistry), etc.

6. Has the student ever had a tutor before?
YesNo
If yes, please indicate when those sessions took place, what subjects were covered by the tutor and whether or not the student responded positively towards the experience.

7. Which of the following categories best describe the student's learning style?
Visual (learns best by reading notes and studying diagrams)
Auditory (learns best with verbal instructions)
Tactile (learns best with manipulatives; for example, will better understand cylinders by observing an actual can of soup rather than a diagram of one.)
Rote (learns best through repetitive drills)
Applied (learns best through real-life examples and analogies)

E) Character Profile

1. For each of the following attributes, please rate the student on a scale of 1 (weak/low) to 7 (strong/high) by typing the appropriate number into each field.
Motivation
Creativity
Focus/attention span
Self-esteem
Independence
Patience
Curiosity
Pride in workmanship and performance
Social skills
Easy-going temperament
Extroversion
Ability to multi-task
Sense of humour
Ability to handle stress
Work ethic
Ability to process information quickly
Enjoyment of school
Respect for deadlines
Listening skills
Ability to follow instructions

2. Please list any volunteer work that the student has performed, including community service hours for high school credit.

3. Please list any extra-curricular activities that occupy the student's free time. For example, sports, hobbies, interests, etc.

4. What are some of the goals or aspirations that the student has for his/her future?

F) General Information

1. What advice, specific to the student, would you offer a tutor in order to maximize the effectiveness of any private tutoring session between them?

2. Would you like The Learning Curve to contact any of the student's teachers?
YesNo
If yes, please list their names below along with any known contact information.






3. What are the student's and parents' expectations as far as private tutoring is concerned?

4. From what source did you find out about The Learning Curve's services?

a) If you conducted an online search, what were the key words that you used?

b) If this is a word-of-mouth request, feel free to include the name(s) of any tutor(s) who may have been specifically recommended to you.