TCC Client Intake Form • The Community Classroom

Your Name*

First Last

Email*

Phone*

Timeline*

How soon are you looking to start tutoring sessions?

ASAP!
2 Weeks
1 Month
1-3 Months

Online or In Person*

Address*

Please note in-person tutoring is currently only available in Western Massachusetts.

Street Address City Massachusetts ZIP Code

Name of Student*

First Last

Birthday of Student*

Current Student School Level*

Pre-K Subject Matter*

What subject matter does your student need assistance with.

Elementary Subject Matter*

What subject matter does your student need assistance with.

Middle School Subject Matter*

What subject matter does your student need assistance with.

High School Subject Matter*

What subject matter does your student need assistance with.

Other Subject

Tutoring Schedule & Frequency

Please tell us how often you are seeking tutoring, days of the week you prefer, and times of day you prefer.

What Does Your Child Love To Do?*

Letting us know their outside school interests helps us better understand what type of tutor they might pair well with. Check all that may apply. Choose "Other" if you would like to tell us about activities not listed.

Other Student Interests*

Tell us about the interests your student has that we didn't have listed!

Games & Activities*

List some board games and/or activities (electronic or otherwise) your student enjoys playing.

Student Learning Strengths*

What are your child’s strengths as a learner?

How is your child doing in school? What are you hearing from their teacher? Seeing at home?*

What is an area of concern that you have?*

Specific needs, wants, or visions you have for certain subjects.*

Please list in reference to the subject(s). Example: Math, Reading, Writing, Communication, Science, Social Studies, Art, Music, etc.

How does your child feel about learning?*

Tutor Preferences*

What qualities and characteristics does your child prefer in a teacher?

Learning Artifacts Upload

Though not required, sharing any type of work sample could help us learn a lot about your student. This could be a test(s), writing samples, syllabus, work samples, etc. Must be in jpg or PDF form. All content submitted is kept confidential and not shared. You will have an opportunity to submit items later as well.

Drop files here or

Accepted file types: jpg, jpeg, pdf, Max. file size: 32 MB, Max. files: 4.

Caregiver Interview Form

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Caregiver Interview Form

Join The Classroom

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