Today’s Date
12-10-2020
Student’s Name
Sean Ferguson
Birthdate
11-07-2006
Parents’ or Guardians’ Names
Toni Ferguson
Street Address
4020 Red Canoe Bend
City
Lilburn
State
Georgia
Zip
30047
Parent/Guardian E-mail
ferguson3587@bellsouth.net
Primary Phone #
770-778-9136
Employer(s)
GCPS
Work Phone (Mom)
7709212400
Parent’s Contact Cell phone
770-778-9136
Work Phone (Dad)
School student is attending now (if applicable)
Trickum MS
Grade Level
Eighth
In what area(s) of academics are you seeking assistance?
Physical Science and Social Studies
(If school course) Textbook Title
ISBN#
If E-class and/or online textbooks, note here your USERID
PASSCODE
PARENT’S INITIALS
TF
(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?
Currently for Algebra I and Physical Science
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?
Older son attended
Conference dates and times:
Flexible
Final Exam Review Class Course:
$50 deposit only if student is already enrolled for this school year = $50