After-School Tutoring Needs Assessment
Student Information
Student Name
Grade Level
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Parent/Guardian Name
Parent/Guardian Email
Area(s) of Academic Need
Which subject(s) does the student need support in?
Math
Reading
Science
Social Studies
Other
If other, please specify:
Challenges
Briefly describe the main academic challenges the student is facing:
Preferred Tutoring Schedule
Which days is the student available for tutoring?
Mon
Tue
Wed
Thu
Fri
Preferred Time(s)
Goals
What would you like the student to achieve through the tutoring program?