1to1TUTOR ENROLLMENT REQUEST FORM

SUMMER PROGRAM ENROLLMENT REQUEST FORM

Student's Name*	First
	Middle
	Last

Address 1 :	Number
	Street
	City
	State
	Zip

Subject:

Book Name:
Author:
ISBN number:

Student's Grade:
Male
Female

Telephone:	Daytime
	Evening
*E-mail:**

*Parent's Name:**
	First
	Last
Parent's *E-mail:**
Pricing structure :
Desired sessions:	/ Week

Time Zone:

I am available on:

Monday	Tuesday	Wednesday	Thursday	Friday	Saturday

*The above timings are preferred ones. Actual schedules can differ


	Areas in which you need help :

Have you been previously enrolled at 1 TO 1 TUTOR ?

Yes

Referred By:

What are your expectations?:

Educational Kits Package Policy And Tuition Policy

1to1tutor will send educational kits package that includes headset, whiteboard, and light pen upon registration. Upon cancellation of service, the educational kits package shall be returned to 1to1tutor office located at 25 Mauchly # 319, Irvine, CA 92816, in good working condition and functional order. The unused tuition fees will be refunded to you upon receipt of the educational kits package to our office. 1to1tutor has the right to hold the unused tuition fees if educational kits package appears to be in poor condition and non functioning order.
Tuition Policy : Individual books will be available for students who are registered for 12 sessions or more.

By clicking this button, I have read and understand the terms and conditions stated above.

I Agree