Name of Student Age Grade School Parent MotherFather Name of Parent Address Telephone Your Email Please indicate your preferred method of communication PhoneEmail Please indicate the best time to contact you Between 9:00-12:00Between 12:00-5:00 Please select the type of service TutoringOrthopédagogieSpecial Education (please specify in next section)Ministry Exam Preparation Séances de préparation pour les examens du Ministère (en petits groupes) 📘 Secondaire 4 • Mathématiques TS et SN • Mathématiques CST • 📚 History of Quebec and Canada (ENGLISH) 📗 Secondaire 5 • English Language Arts (Core) 📙 Primaire 4e année • Lecture • Écriture (COMPLET) 📕 Primaire 6e année • Lecture et écriture • Mathématiques Veuillez préciser / Please specify FrenchEnglishMath (in French)Math (in English)OtherSpecial Education: Private sessions for studentSpecial Education: Private sessions for parent and/or family Please indicate further information about your child ex: intervention plan, learning disorder, etc