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ACACIA EDUCATIONAL SUPPORT

 2010-2011 School Year

 

If you are reading this you consider education important.  You have also realized that someone in your household needs some additional support.  In order to be of service, we need some information about the student seeking support.  First, there are some forms to fill out.  Click on the links below and print and complete these forms at home.  Please bring these forms to your first meeting with an Acacia mentor.

Student Questionaire                               Information Sheet                                Emergency Contact Form

Next, we need to know when we can meet with the student and the subjects in which they need support.  Complete all the information below to signup for an appointment to begin educational support.  Someone will contact you to confirm the appointment.  We will do our best to honor choices based on mentor(s) who are available at those times.

*Student First Name:      *Student Last Name: 

Street Address:

City:    State:    Zip Code:

*Parent/Guardian First Name:    *Parent/Guardian Last Name: 

*Contact Phone Number:      *Contact Email: 

*School District:      *Grade Level:

*Trimester:     *Desired Start Date:

First Choice: Tuesday       OR       Thursday  

Second Choice:  Tuesday      OR        Thursday   

 I would prefer to meet with a mentor one on one                     I don't mind meeting in a group

 *Subject(s) you want help with:       Math -       Science -

                                                   Communication Arts -     

                                                   History -   Language -

  Study Skills                           Organizational Skills                     Preparing for Tests


*Required Fields