Request a Consultation

Complete the form below to help me better understand your learner's needs. I will contact you to schedule our consultation and tutoring sessions.

Parent/Guardian First name*

Parent/Guardian Last name*

Relationship to Student*

Email*

Phone

Student Name

Student Age

Grade Level

Seeking Support in:

Reading

Math

Homework Help

Executive Functioning (Organization & Study Skills)

Academic planning for families

Other

What specific concerns or goals do you have for your student?

Has your student received tutoring before?

Yes

If yes, what worked well?

What didn't work well?

Does your student have an IEP, 504 Plan, or learning accommodations?

IEP

504 Plan

Informal Accommodations

If yes, please describe any key information or upload documents (optional):

How does your student learn best? (Check all that apply)

Visual (pictures, diagrams, videos)

Auditory (hearing explanations)

Hands-on/Interactive

Step-by-step breakdowns

Real-world examples

Movement-based learning

Other

What motivates your student?

Tell me anything else I should know about your student (strengths, interests, challenges, attention needs, allergies, behavior notes, etc.):

Preferred Meeting Day (for tutoring sessions)

Preferred Meeting Time (for tutoring sessions)

Please check each box to confirm each agreement.

I understand that payment is due prior to each session.

I agree to the 24-hour cancellation policy.

I agree to support a quiet, distraction-free environment during tutoring sessions.

I consent to communication regarding my student’s progress.

Signature

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Contact Me

Tel: 260.503.5400

Email: vedderdesigns@gmail.com

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