Request for a Tutor

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Request for a Tutor Form

DATE
CASA NAME(required)
CASA EMAIL(valid email required)
CASA PHONE
CASE NAME
Student's Legal name
Grade
Name Student Prefers
STUDENT'S GENDER
Female Male
Foster parent's Name
Address
City
Zip
Foster Parent's Contact Info
School
Teacher/Counselor
Phone or e-mail
Does the student have a tutor preference?
Older Younger Female Male None
Explain the Student's Needs (Example - One subject, two subjects, all subjects, specific areas in reading, specific areas in math, etc)
Student's Special Needs: (e.g. Speech therapy, IEP, ESL, ADHD)
Days & times the student is available for tutoring (ie specific days of the week, specific hours each day)
CASA's availability to meet with the tutor (ie specific days of the week, specific hours each day)
Other info:

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