Request for a Tutor

CASA SUPPORT COUNCIL FOR PIMA COUNTY, INC.

* Click Submit below when finished with the form.

DATE*
YOUR NAME*
YOUR EMAIL*
YOUR PHONE*
COORDINATOR'S NAME*
STUDENT'S LEGAL NAME*
GRADE*
NAME STUDENT PREFERS*
STUDENT'S GENDER*
- MALE
- FEMALE
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
- MALE
- FEMALE
- 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*
Name
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