Today’s Date
01-18-2021
Student’s Name
Jordyn Malone
Birthdate
11-17-2003
Parents’ or Guardians’ Names
Tonia Malone
Street Address
1283 Silver Trace Drive SW
City
Lilburn
State
GA
Zip
30047
Parent/Guardian E-mail
Toniamalone@comcast.net
Primary Phone #
770-668-4698
Employer(s)
N/A
Work Phone (Mom)
770-668-4698
Parent’s Contact Cell phone
770-668-4698
Work Phone (Dad)
770-668-4698
School student is attending now (if applicable)
Greater Atlanta Christian School
Grade Level
11th
In what area(s) of academics are you seeking assistance?
ACT/SAT Prep Course
(If school course) Textbook Title
ISBN#
If E-class and/or online textbooks, note here your USERID
PASSCODE
PARENT’S INITIALS
TSM
(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?
Yes
If yes, who, when, and in what area of academics?
TLC
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?
Prior Client
Conference dates and times:
N/A
PSAT/SAT/ACT Preparation Course:
$100 deposit + $35 returning student fee = $135