TUTORS TO YOU ENROLLMENT FORM

I WANT TO BUY NOW Click here to order now by check, money order, credit card, or PayPal. A Tutors to You representative will be in touch shortly after you place your order, at which time you can give details on scheduling and student needs. To speed the process, feel free to call us immediately after placing your order. Los Angeles area: 310.709.8709 San Fernando area: 818.761.2084 Cleveland area: 216.659.6007 I WANT TO GIVE DETAILS ONLINE OR REQUEST A PHONE CONSULTATION If you'd like to set up a phone consultation before placing your order, or if you'd like to include details about the prospective student along with your order, fill out the form below and click "enroll." Once your form is received, a Tutors To You rep will call to discuss our services, or—if you have already paid—schedule your lessons. If you intend to purchase a package, just click the Order Now link after you submit this form to pay by credit card or PayPal. Alternatley, you can also pay by phone, or mail in a check/money order. Contact Information Student's Name: *      Student's Nickname (if any):    Student's Date of Birth Month/Day/Year --select--JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember12345678910111213141516171819202122232425262728293031 1965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010 Student's Grade Level:      --- Choose from list --- First Second Third Fourth Fifth Sixth Seventh Eighth High School Freshman High School Sophomore High School Junior High School Senior College Freshman College Sophomore College Junior College Senior Postgrad Homeschool other Name of Current School:  Areas of Academic Concern (please describe):      Name of Parent/Guardian:   E-mail Address: *      Address, line 1: *      Address, line 2:      City: *      State: *      --- Choose from list --- California Ohio ZIP Code: *      Cell Phone:  Home Phone: Where Are You Currently Employed:      How Many Sessions Would You Like see pricing:      --- Choose from list --- One Lesson Package Four Lesson Package Eight Lesson Package Twelve Lesson Package Sixteen Lesson Package Twenty Lesson Package Twenty-Five Lesson Package Fifty Lesson Package Where Would You Like Tutoring to Take Place:      --- Choose from list --- Our Home The Local Library Other If Other, Please Specify:    Which Days Would You Like Tutoring: Hold down Control Key to select multiple options   Monday Tuesday Wednesday Thursday Friday Saturday Sunday At What Time (i.e. 5:00 Tuesday and 7:00 Thursday) On What Date Would You Like Tutoring to Commence How Did You Hear About Tutors to You:      --- Choose from list --- Newspaper Flyer Postcard Internet Email Word of Mouth other If Other, Please Specify: