Corban Academy Registration

Parent Information

Parent First Name

Parent Last Name

Parent Birthdate

Parent Email Address

Parent Phone

Parent Mailing Address

Country

Street

City

Region

Postal Code

Student Information

Student First Name

Student Preferred First Name (if different from above)

Student Last Name

Student Birthdate

Current Grade Level

HIDDEN: Age

Would you like your student to receive email from Corban University Admissions?

Yes

No

Student Email

Anticipated High School Graduation Year

Tutoring

Tutoring sessions are available on Corban University's campus or online. Both environments are safe, free of controversial materials, and monitored. All tutors are 18 or over with clean background checks.

What is your primary goal with tutoring?

Enrichment (additional/accelerated knowledge of topic)

Support (clarity/understanding of topic)

What format do you prefer for tutoring sessions?

On campus

Online

Either

For which subject(s) does your student need tutoring? ($160 per topic, for one month of weekly tutoring)

Algebra 1

Algebra 2

Calculus

Geometry

Basic Writing Skills (writing supports, topic development, collaborative editing)

Advanced Writing Skills (writing supports, topic development, collaborative editing, focus on college ready form and presentation)

HIDDEN: Tutoring Subject Count

HIDDEN: For which month(s) would you like tutoring?

March

April

May

Please indicate 3 days and times that work for your schedule for tutoring.
*We will do our best to accommodate your request, and if we have questions, we will contact you directly.

Preferred Day 1

Preferred Time 1

Preferred Day 2

Preferred Time 2

Preferred Day 3

Preferred Time 3

Is there anything else you can tell us about your tutoring requests? Specific information about your student's needs, challenges, and learning style will help us provide a more valuable tutoring experience.

Are you interested in group tutoring if it is available?
This would be a group of 2-3 students who are receiving tutoring at the same instructional level and content area. If we find students qualify for a group based on these criteria, we will reach out to let you know.

Yes

No

Other notes or comments:

Agreements

As a visitor to Corban University, I acknowledge that there are certain dangers inherent in any activity and that bodily injury could occur while on campus. I agree that I will hold Corban University, its staff, and representatives free from any and all liability for any and all accidents or injuries occurring to the participant(s) as a result of participation in this event, and hereby release Corban University, staff, and representatives from any and all such liability.

I agree

I, the parent/guardian, of the above-named child, grant Corban Academy and its representatives the right to photograph or film my child and to use this content in print and/or digitally for future marketing purposes for Corban Academy.

Yes, I give my permission

No, I do not give my permission

Parent Signature

Payment

HIDDEN: Total Tutoring Cost

Amount Due
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Amount Due

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