Today’s Date
06-04-2021
Student’s Name
Disha Rachur
Birthdate
12-18-2004
Parents’ or Guardians’ Names
Radharani Gopireddy
Street Address
5887 stow drive
City
Tucker
State
GA
Zip
30084
Parent/Guardian E-mail
ranitest@gmail.com
Primary Phone #
+1 (470) 354-9545
Employer(s)
Mckesson
Work Phone (Mom)
4047282428
Parent’s Contact Cell phone
6784576435
Work Phone (Dad)
School student is attending now (if applicable)
GSMST
Grade Level
10
In what area(s) of academics are you seeking assistance?
SAT (LA, Math)
(If school course) Textbook Title
ISBN#
If E-class and/or online textbooks, note here your USERID
PASSCODE
PARENT’S INITIALS
RG
(If virtual sessions) SKYPE contact ID & phone #/email
If the student has any learning differences about which we should be aware, please explain
Have you ever used a tutor or learning center before?
No
If yes, who, when, and in what area of academics?
Please circle days and times when this student can attend sessions:
Sun. Afternoon
How did you hear about Total Learning Concepts or who referred you?
Annie Abraham
Conference dates and times:
NA
PSAT/SAT/ACT Preparation Course:
$100 deposit + $65 new student enrollment fee = $165