Today’s Date
12-10-2020
Student’s Name
Leyona Zackery
Birthdate
12-10-202010082008
Parents’ or Guardians’ Names
Angela Stephens Mains
Street Address
399 Adams Farm Lane
City
Lawrenceville
State
GA
Zip
30046
Parent/Guardian E-mail
queenstephens@yahoo.com
Primary Phone #
6787895341
Employer(s)
Greater Atlanta Christian School
Work Phone (Mom)
6787895341
Parent’s Contact Cell phone
6787895341
Work Phone (Dad)
7708952468
School student is attending now (if applicable)
Greater Atlanta Christian School
Grade Level
7
In what area(s) of academics are you seeking assistance?
Final Exam Review Class
(If school course) Textbook Title
Science
ISBN#
If E-class and/or online textbooks, note here your USERID
PASSCODE
PARENT’S INITIALS
ASM
(If virtual sessions) SKYPE contact ID & phone #/email
If the student has any learning differences about which we should be aware, please explain
Dyslexia
Have you ever used a tutor or learning center before?
yes
If yes, who, when, and in what area of academics?
Sylvan 4 years ago
Please circle days and times when this student can attend sessions:
Mon. Afternoon Evening, Tues. Afternoon Evening, Wed. Afternoon Evening, Thurs. Afternoon Evening, Fri. Afternoon, Sat. Morning Afternoon, Sun. Afternoon
How did you hear about Total Learning Concepts or who referred you?
Lauren Hollier, Dean of Academics
Conference dates and times:
Saturday afternoon or any day after 3:45 PM
Final Exam Review Class Course:
$50 deposit only if student is already enrolled for this school year = $50