Dawn Learning Center | Tutoring Application

Parent Name 1

Parent Name 2

Address

Street Address

Apt, Suite, Bldg.

(optional)

City

State / Province / Region

Postal / Zip Code

Country

Preferred Phone

This phone number is for the main parent/guardian contact for the child. Please format XXX-XXX-XXXX (optional) ext.XXXX

Is this your:

HomeCellWork

Child's Name

Please include first name, middle initial, and last name

Child's Preferred Name

Child Phone

This is an optional field for the child. Please format XXX-XXX-XXXX

Child Email

Birthdate

Student Grade Level

School Name

School Address

Street Address

Apt, Suite, Bldg.

(optional)

City

State / Province / Region

Postal / Zip Code

Country

School Phone

Please format XXX-XXX-XXXX

School Fax

Please format XXX-XXX-XXXX

General Application Questions

DLC offers tutoring in Math and English. Please select the desired tutoring subject below

MathEnglishBoth

List your desired tutoring hours for the days selected above.

Please list your desired times as: day, hour increment, subject (For example: Monday, 5-6, Math)

Any other comments you wish to provide DLC

Verification

Please enter any two digits

Tutoring Application