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1. Subjects to be provided? (Check both if both are needed)

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2. Type of services needed?

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3. Does each school location have a dedicated room for In-School tutoring from Monday to Friday?

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4. Does each school location have a dedicated room for After-School tutoring for 2-4 days a week?

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5. Does each school location have a dedicated room for Summer Bridge tutoring for 2-4 days a week?

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6. Does each campus location have a dedicated liaison for the Beacon Hill Partnership?

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7. Does your school have a dedicated budget for services?

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8. School Campus:

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9. Principal Name:

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10. 1st Point of Contact Name:

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11. 2nd Point of Contact Name:

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12. Office or Cell Number:

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13. Number of students to be served:

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14. Demographics of campus:

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15. Projected # of students to be served per subject:

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16. Grades to be served:

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17. Tentative Start Date:

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18. If known, what is the budget per student?

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19. What is the budget per program? (Math or Reading)

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20. What is your preferred date and time to meet via Zoom to discuss this program?

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21. How did you hear about our program?

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