Student Intake Form
Thank you for your interest in The Sunshine Method tutoring! Please complete the student referral form as thorough as possible to help facilitate the tutor matching process.
Progress Report/ Test Scores
section, please provide information regarding the child's grades, progress reports, E.O.C. scores, and I.E.P. if applicable. Also please provide any special accommodations or additional background information that is needed/helpful to best assess the student, along with the
Child's availability (days & times) they can receive tutoring.
If you have any questions, please contact us at 786-266-5513 or 786-717-3025!
Parent/Guardian First Name
Parent/Guardian Last Name
Address Line 2
Please provide Agency name (Case manager name/number/email REQUIRED), Health Insurance Name (MEMBER ID REQUIRED), OR mark Private Pay if you will be paying out of pocket
Additional Child Background Info (personality, interests, likes, dislikes, where they need improvement, any mental health diagnosis, chronic conditions, etc.). Also include availability for tutoring, and preferred location (if not in the home) * TO PREVENT THE SPREAD OF COVID-19, ALL TUTORING IS CURRENTLY ONLINE. PLEASE SPECIFY IF YOU ARE INTERESTED IN VIRTUAL TUTORING FOR THE TIME BEING.
Subjects Child Needs Help With / Relevant Progress Reports & Test Scores
Add Fields for Additional Student