Parents’ or Guardians’ Names
Tyndal Michele Jones
1655 Hatteras Trail
Primary Phone #
Signature Women's Healthcare
Work Phone (Mom)
Parent’s Contact Cell phone
Work Phone (Dad)
School student is attending now (if applicable)
Greater Atlanta Christian 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?
Please circle days and times when this student can attend sessions:
Wed. Afternoon Evening
How did you hear about Total Learning Concepts or who referred you?
Ms Byrd from GAC
Conference dates and times: