Contact Form ← BackThank you for your response. ✨ Child's Name and Current School:(required) Warning Student(s) Age & Grade:(required) Warning What is the best way to contact you?(required) Call Text Email Warning Parent(s) or Guardian(s) Name:(required) Warning Best phone number and email address:(required) Warning What type of school does your child attend?(required) Public School Private School Homeschool Co-Op Warning What are your child's best qualities? i.e. Kind, Determined, Caring, Team Player (tell us how great your child is)(required) Warning 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) Warning 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 Warning Would you be open to group tutoring sessions-up to 3 children? If yes, do you have other families in mind? (required) Warning What are your areas of concern with your child's academic performance and learning? What are your goals?(required) Warning Has your child's teacher expressed concerns? If yes, please explain.(required) Warning How does your child feel about their ability? Academic? Social?(required) Warning Does your child have an IEP or 504 Accommodations??or 504 Plan? If so, please write a brief description of his/her plan.(required) Warning Does your student have a medical diagnosis that I should be aware of? If so, please give a brief description.(required) Warning What additional Information would you like to share with me? Warning 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) Warning Warning. 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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