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E3 Learners Small Group Math Interest Form
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1.
Parent/Guardian Name
(Required.)
*
2.
Email Address
(Required.)
3.
Phone Number
*
4.
What grade level(s) are your child(ren) entering?
(Required.)
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Other (please specify)
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5.
How many children are you interested in enrolling?
(Required.)
1
2
3
4
Other (please specify)
6.
What time of day would work best for your family?
Morning
Afternoon
Early Evening
Flexible
Other (please specify)
7.
Which days are you most interested in?
Monday
Tuesday
Wednesday
Thursday
Friday
Flexible
8.
How often would you prefer sessions each week?
One session per week
Two sessions per week
Three sessions per week
Four sessions per week
Five sessions per week
9.
Would you like optional practice work or activities between sessions?
Yes
No
Maybe
*
10.
What are your child’s greatest math needs or goals right now?
(Required.)