Contact Form ← BackThank you for your response. ✨ Child's Name and Current School:(required) Student(s) Age & Grade:(required) What is the best way to contact you?(required) Select an option Call Text Email Parent(s) or Guardian(s) Name:(required) Best phone number and email address:(required) What type of school does your child attend?(required) Select an option Public School Private School Homeschool Co-Op What are your child's best qualities? i.e. Kind, Determined, Caring, Team Player (tell us how great your child is)(required) What does your child struggle with educationally and personally (if applicable)? What changes are you looking for? i.e. Educational: doesn't complete homework or study for tests Personally: Anxiety, Quick to Anger- lashes out at walls.(required) Which days and times are best for you? (Check two)(required) Tuesday Homeschool 10am-2pm Tuesday After School: 3-6pm Wednesday Homeschool 10am-2pm Wednesday After School: 3-6pm Thursday Homeschool 10am-2pm Thursday After School 3-5pm Would you be open to group tutoring sessions-up to 3 children? If yes, do you have other families in mind? (required) What are your areas of concern with your child's academic performance and learning? What are your goals?(required) Has your child's teacher expressed concerns? If yes, please explain.(required) How does your child feel about their ability? Academic? Social?(required) Does your child have an IEP or 504 Accommodations??or 504 Plan? If so, please write a brief description of his/her plan.(required) Does your student have a medical diagnosis that I should be aware of? If so, please give a brief description.(required) What additional Information would you like to share with me? What program or programs are you interested in?(Check all that apply)(required) Orton-Gillingham Reading Tutoring Math Tutoring 1305 Practice Executive Functioning Program Private Yoga & Meditation Sessions (Youth/Family) Private Meditation Sessions (Adult) Submit Δ Share this: Share on Facebook (Opens in new window) Facebook Share on Pinterest (Opens in new window) Pinterest Email a link to a friend (Opens in new window) Email Like Loading...
Eden & Einstein Academy 
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