Core Service Tutoring
Spotlight Service Tutoring
Co-Pilot Service Tutoring
(What Service Is Right?)
Handwriting / Keyboarding
Executive Functions Coaching (PEG)
Educational Testing and Evaluation
ISEE / HSPT / SSAT Prep
College Essay Writing Guidance
Friends of QWERTY
QWERTY Education Services
Form Test – Student Information Form
Student Information Form
Name of Parent or Guardian #1:
Name of Parent or Guardian #2 (Optional):
Primary Phone Number:
Address Line 2
ZIP / Postal Code
Mobile Phone (Parent 1):
Mobile Phone (Parent 2):
Email Address (Parent 1):
Email Address (Parent 2):
Student Mobile Phone (optional):
Student Email Address (optional):
Please indicate a contact preference order (1, 2, 3, etc.) for all phone numbers, home and/or mobile:
Mobile Phone (Parent 1)
Mobile Phone (Parent 2)
Is email a reliable way to communicate with you?
May we contact you via email with QWERTY-related news? (2-3 times yearly)
Do you use Facebook?
Do you use Nextdoor?
Have you ever written a Yelp! review?
Alternate contact(s) in case of emergency (name, relationship, contact phone #):
Are there any medical concerns to be aware of while this student is working at QWERTY (possible diabetic reaction, seizures, allergies, etc.)?
Special instructions in the event of a medical or other emergency:
Please confirm your EMAIL address for billing (PDF format):
(Write "Paper" if you prefer bills sent via USPS to your home address):
Payment is due during the month in which your PDF invoice is received by mail or email. We encourage email to save paper. A non-optional late fee of $10 will be added for payments received after the due date. Payment 2 months late are subject to an additional $30 late fee, and 3 months late will be subject to an additional $60 late fee. Your prompt payment helps simplify our accounting and is sincerely appreciated.
Tutoring: $125/hr on schedule and $145 off schedule.
$625 Spotlight Tutoring Package
Co-Pilot Tutoring $90 per hour
Standardized Test Prep: $135 per hour on schedule and $155 per hour off schedule.
Executive Functions Coaching $140 per hour
Writing Workshops (8 sixty-minute sessions, Monday through Thursday for 2 consecutive weeks): $640
College Essay Writing: Introductory Package (4 sessions): $540, Additional Sessions: $150 per hour
Scheduling and Cancellation:
Please phone as far in advance as possible if you are unable to keep a scheduled appointment, providing the reason for the absence. You will be billed for appointments missed without
. Students may attend tutoring on school holidays, if they choose and the tutor is available.
Since holiday schedules vary in different schools, it is your responsibility to confirm your schedule for those days.
Please type your full name to certify that you have read and understand the above.
How did you hear about us?
Did you learn about us from another past or present family that has worked with us?
Were you referred to QWERTY by a professional? (Teacher/Education Professional/Other).
What is this person's profession? (Teacher/Educational Professional/Other).
Did you hear about QWERTY through a Website or Social Media? (please select all that apply)
Other Search Engine
Search words used (if known):
Other Referral Source (please specify):
This iframe contains the logic required to handle Ajax powered Gravity Forms.
Start typing here...