TransparentingLives

Full Name *
Preferred Name / Nickname: *
Phone *
Email *
DOB *
Address *
Grade / Education Level *
School Name (if applicable) *
Primary Learning Goal(s) *	K-5 foundational skills Middle school support High school core courses End-of-Course (EOC) exam prep College entrance exam prep (ACT/SAT) College-level coursework support Adult GED prep ASVAB prep Academic refresher (adult) Other
Specific Subjects of Interest / Focus *
Current Challenges / Academic Concerns *
Previous Tutoring or Academic Support Received *
Learning Preferences	Preferred session format: In-person Virtual Hybrid Best learning style: Visual Auditory Kinesthetic Reading/Writing Unsure
Preferred days/times for tutoring *
Accommodations / Educational Plans:	IEP / 504 Plan in place I need support for learning differences or access needs
Brief description of how we can best support *
Parent / Guardian Information (Required if student is under 18) *
Relationship to Student *
Email: *
Phone *
Preferred Contact Method *
Secondary Contact (optional): Name
Phone
Are you enrolling as an adult learner?	Yes No
Highest level of completed education *
Primary goal *
Desired Start Date *
Session Frequency Preference *	Weekly Biweekly Intensive / Bootcamp As-needed
Typical Availability (days/times) *
Preferred Payment Method *	Credit/Debit Card ACH/Bank Transfer PayPal Cash App/ Venmo Other
Intended Package: *	Single Session 5-Pack 10-Pack Custom Plan
Scholarship / Sliding Scale Request *	Yes No
Emergency Contact Name *
Phone *
Relationship *

Phone:

904-265-5173

Email:

info@transparentingco.org

Address:

3450 Dunn Ave.
Suite 301
Jacksonville, FL 32218