Contact — Madigan Tutoring Services

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Let’s Learn Together

Intake Form

Inquiry and Registration Process:

1) Complete intake form below

2) Schedule a New Student Consultation on our Book Now page

3) After our phone call, complete New Family Agreement

4) Activate automatic monthly payment schedule

5) Scheduling begins: evaluation(s), and regular sessions

General Inquiries:
Madigantutoring@gmail.com
734-730-7325

Estimated time to complete form:
5-10 minutes

Child's Name *

First Name

Last Name

Child's Birthday

MM

DD

YYYY

Main Point of Contact *

Parent/Guardian's Name

First Name

Last Name

*

Parent/Guardian's Phone Number

(###)

###

####

*

Parent/Guardian's Email

Additional Parents/Guardian's Name(s), Phone(s), Email(s):

Tutoring Availability *

Please list ALL days and times your student is available Sunday through Thursday.

List your student's current grade, school name, and teacher's name. Then tell me about your child's learning strengths: *

Ex: Ann Spencer, grade 1, RHE, Ms. Teodoro.

Please indicate any of your child's medical needs and services that I should note, including medical and educational diagnosis (AHDH, ASD, dyslexia, anaphylactic allergy, etc.). Include main points of their IEP or 504 Plan, if applicable. You may include undiagnosed symptoms you are interested in discussing. *Note: we are not medical professionals.

i.e Include location of Epi Pen if needed (bring to every session), how long they've had their IEP, are they in speech therapy, etc.

Topics you would like us to focus on, select all that apply. Note that we will need to complete at least one evaluation for literacy topics, and one evaluation for math topics if you select multiple areas of focus.

Reading Fluency

Reading Comprehension

Spelling

Writing

Handwriting

Singapore Math Curriculum

Mental Math

Math Story Problems

Standardized Testing Prep

All of the Above

Only Supporting Classroom Math Work (teacher guidance required)

Tell me about your child's learning needs, goals, and opportunities:

Do you have a copy of your last parent-teacher conference notes, school report cards, progress reports, or assessments from outside specialists that you can share with me? A recent newsletter? An email from a current teacher indicating topics we might focus on?

If so, please email to Madigantutoring@gmail.com

Please list any educators that I may communicate with, if needed (include contact information). Note that LT requires guardians to complete a form with your school office to give permission for MTS to communicate with LT staff.

What topics does your child love? I will try to work these into our lessons!

Do you read with your child every night before bed?

Yes

No

Often

Inconsistently

Would you like your child's tutoring program to include age-appropriate reinforcement work?

Yes

No

Maybe

Sometimes

How did you hear about us? Who may we thank?!

Social Media Post

Website

Google Search

Referral

Book your New Student Consultation after sumbitting this form:

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Thank you!