Parent Input FormDate* Date Format: MM slash DD slash YYYY Student Name* First Last Date of Birth* MM DD YYYYGrade*Parent(s) filling out form*Email* Phone*What goals do you hope your child will achieve through tutoring?*What concerns do you have about your child’s academic performance?*How do teachers generally describe your child?*With your child's school performance in mind, please complete the following:Well-developed Skills*Under-developed Skills*Is there any additional information that would be helpful for us to know, such as testing, special classes, medical conditions, allergies, etc.?*YesNoPlease ExplainPARENT EXPECTATIONS for Allocation of Tutoring TimeWhat are your expectations for your child's tutoring time? During the school year, students often want to do homework during tutoring, but some parents may not want to pay us just to help with homework. List the percentages of time you wish us to allocate working on specific needs for your child.Fill out the blanks to indicate how you would like your child's tutoring time allocated:Percentage % of time on homework (if currently in school)*Please check one* any subject specific subject(s)List specific subject(s):*Percentage % of time on improving/developing academic skills*List specific skills*100% TotalPARENT AUTHORIZATION for Contact with School[NOT APPLICABLE FOR SUMMER TUTORING unless received by May 1] In order to provide the best possible service, it can be helpful for us to be in contact with the school personnel that work with your child every day. With your permission, we e-mail letters of introduction to teachers requesting information about the class and your student. We copy you in all emails we send to and receive from the teachers.Would you like us to contact teachers?* NO (no need to provide further info - SKIP TO SIGNATURE BELOW) YES, email them NOW to let them know we are working with your child (email addresses required): YES, but only if questions/problems arise (email addresses required):TeacherSubjectEmail TeacherSubjectEmail TeacherSubjectEmail I authorize Susan Morris and other MTA tutors to communicate with teachers and other school personnel at (Name of School below): I also authorize school personnel to release information regarding this student to MTA staff.Name of SchoolSignature*Date* Date Format: MM slash DD slash YYYY CAPTCHANameThis field is for validation purposes and should be left unchanged. Save and Continue Later This iframe contains the logic required to handle Ajax powered Gravity Forms.