2011-2012
FREE TUTORING
Supplemental Educational Services
Directions: Please complete all sections of this form. Please print LEGIBLY and submit the completed form to your child’s school.
__________________________________________________ _______________________________________ ______________
Student Last Name
Student First Name
Grade
_________________________________________________________________________ _______________ __________________
School Name
Date of Birth
____________________________________________________________________________________________________________
Address
_____________________________________________________ _______________________ ___________________________
City
State
Zip Code
_____________________________________________________________ ____________________________________________
Parent’s Last Name
Parent’s First Name
____________________________ ______________________________ ____________________________________________
Parent’s Primary Phone #
Parent’s Cell Phone #
Parent’s Email Address
Select Provider(s): Please select three different providers as your 1st, 2nd, and 3rd choice by checking the appropriate circle(s) in the
space provided below. Only 1 circle per choice.
1st Choice
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
1 to 1 Tutor
A+ Academics
A+ Tutors for Scholars
Abacus In-Home Tutoring
ABLE Tutoring
Accuracy Temp Services (ATS)
Achievia Tutoring Midwest
Alternatives Unlimited
Applied Scholastics
Carver Learning Systems
Christian Fellowship
Circle of Light
Club Z! In-Home Tutoring
College Nannies & Tutors
Educate Online
Grace United
Group Excellence
Growing Scholars
Huddle Learning
Innovative Educational Programs
Kansas City MO School District
Learning4Today
Learn It Online
Learn It Systems
Leatherwood Enterprises
Millennial Academy
MO Learning Unlimited
Project Life Impact
Reunited Counseling & Training
SLC of Lee’s Summit
Success for Today & Tomorrow
Swope Corridor Renaissance
Terry Learning
Tolbert Tutoring
Tutors With Computers
Village Learning Solutions
W.E.B. Dubois Learning Center
2nd Choice
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
1 to 1 Tutor
A+ Academics
A+ Tutors for Scholars
Abacus In-Home Tutoring
ABLE Tutoring
Accuracy Temp Services (ATS)
Achievia Tutoring Midwest
Alternatives Unlimited
Applied Scholastics
Carver Learning Systems
Christian Fellowship
Circle of Light
Club Z! In-Home Tutoring
College Nannies & Tutors
Educate Online
Grace United
Group Excellence
Growing Scholars
Huddle Learning
Innovative Educational Programs
Kansas City MO School District
Learning4Today
Learn It Online
Learn It Systems
Leatherwood Enterprises
Millennial Academy
MO Learning Unlimited
Project Life Impact
Reunited Counseling & Training
SLC of Lee’s Summit
Success for Today & Tomorrow
Swope Corridor Renaissance
Terry Learning
Tolbert Tutoring
Tutors With Computers
Village Learning Solutions
W.E.B. Dubois Learning Center
3rd Choice
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
1 to 1 Tutor
A+ Academics
A+ Tutors for Scholars
Abacus In-Home Tutoring
ABLE Tutoring
Accuracy Temp Services (ATS)
Achievia Tutoring Midwest
Alternatives Unlimited
Applied Scholastics
Carver Learning Systems
Christian Fellowship
Circle of Light
Club Z! In-Home Tutoring
College Nannies & Tutors
Educate Online
Grace United
Group Excellence
Growing Scholars
Huddle Learning
Innovative Educational Programs
Kansas City MO School District
Learning4Today
Learn It Online
Learn It Systems
Leatherwood Enterprises
Millennial Academy
MO Learning Unlimited
Project Life Impact
Reunited Counseling & Training
SLC of Lee’s Summit
Success for Today & Tomorrow
Swope Corridor Renaissance
Terry Learning
Tolbert Tutoring
Tutors With Computers
Village Learning Solutions
W.E.B. Dubois Learning Center
By signing this document, I authorize Kansas City, MO School District (KCMSD) to release my child’s name, address,
phone number, demographic and academic information in addition to my own contact information to the SES/Free
Tutoring providers that I have selected above, to which my child may subsequently sign. I further authorize KCMSD to
release this information electronically and in hard copy.
_____________________________________________________________________ ___________________________
Parent’s Signature
Date
Please return the registration form to your child’s school by January 27