Tutoring & Academic Support Request Form

Welcome to FUNdamentals! Please complete this form to share what you’re looking for and the areas in which you’re hoping Tutoring & Academic Support can support your child.

Adult's First Name*

Adult's Last Name*

Phone

Email*

Multi-line address

Country/Region*

Address*

City*

Zip / Postal code*

Child's First & Last Name*

Child's Date of Birth*

What grade is your child currently in?*

What school does your child currently attend?*

What are you hoping Tutoring & Academic Support can help with? *Check all that apply*

School Readiness / Pre-Academic Skills — letters, numbers, early concepts

Reading

Writing

Math

Homework Support

Attention & Focus

Organization

Planning & Time Management

Task Initiation & Completion — getting started and following through

Study Skills

Executive Functioning Skills

Learning Confidence / Independence

Not Sure — I’d like help determining the best area of support

Other

Has your child received Tutoring or Academic Support before?*

Is there anything else you’d like us to know about your child, or any questions we can help answer?*

How did you hear about us?

Friend / word of mouth

Referred by another healthcare professional

Online search

Social Media

Flier

Other

What happens next?

Once we receive your inquiry, a member of the FUNdamentals team will review the information provided and reach out to learn more about your child’s needs, answer any questions, and determine whether our services may be a good fit. If appropriate, we’ll work with you to schedule an initial consultation and discuss next steps.

Submitting this form does not schedule an appointment or guarantee service availability.

Thank you for taking the time to complete this form.

We look forward to connecting with you!

Sat 9:00 - 1:00

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