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									ABC High School Tutoring Program Application

Student Name: ________________________________ Address: _______________________________ City: ________________ Email: ________________

Grade: _______________

State: __________________ Zip: _________________ Telephone: ____________________________________

Reason for tutoring (Please check one) In /danger of Failing a Class Academic Probation Strengthen skills in Math/ Science SAT/ACT Preparation Other_________

Please list the course(s) in order of greatest need, which you need tutoring Course 1. ___________________________________ Course 2. ___________________________________ Course 3. ___________________________________

Parent Information: Name: ________________________________ (Complete bottom portion only if information is different) Address: _______________________________ City: ________________ email:_________________

State: __________________ Zip: ____________

Telephone: _______________________ email__________________________

Please note that completing an application does not guarantee that your son/daughter will be accepted into the program. If accepted, the student will be notified and will be required to complete a registration packet. Deadline: Please return your completed application to Mr. Stone or the school office, no later than Wednesday November 28, 2009


								
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