Parents’ or Guardians’ Names
1459, Hickory Ln Sw
Primary Phone #
Work Phone (Mom)
Parent’s Contact Cell phone
Work Phone (Dad)
School student is attending now (if applicable)
Parkview High School
In what area(s) of academics are you seeking assistance?
(If school course) Textbook Title
If E-class and/or online textbooks, note here your USERID
(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?
If yes, who, when, and in what area of academics?
I was tutored at Kumon doing academics such as reading and math on Stone Mountain high way from 2015 - 2018.
Please circle days and times when this student can attend sessions:
How did you hear about Total Learning Concepts or who referred you?
Sabrina Eyasu referred me to Total Learning Concepts .
Conference dates and times:
Thursday at 4
PSAT/SAT/ACT Preparation Course:
$100 deposit + $65 new student enrollment fee = $165