Today’s Date
12-08-2020
Student’s Name
Kaleb Lewis
Birthdate
10-12-2004
Parents’ or Guardians’ Names
Kenya Lewis
Street Address
5530 Chelsen Wood Dr
City
Johns Creek
State
Ga
Zip
30097
Parent/Guardian E-mail
kenyaalewis@yahoo.com
Primary Phone #
4043760937
Employer(s)
N/A
Work Phone (Mom)
4043760937
Parent’s Contact Cell phone
4043760937
Work Phone (Dad)
School student is attending now (if applicable)
GACS
Grade Level
11
In what area(s) of academics are you seeking assistance?
Finals
(If school course) Textbook Title
DC History and DC Honors Anatomy
ISBN#
If E-class and/or online textbooks, note here your USERID
PASSCODE
PARENT’S INITIALS
I do not
(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?
Please circle days and times when this student can attend sessions:
Sat. Morning Afternoon, Sun. Afternoon
How did you hear about Total Learning Concepts or who referred you?
Current student
Conference dates and times:
N/A
Final Exam Review Class Course:
$50 deposit only if student is already enrolled for this school year = $50