Enrollment Application

Welcome to Math Academia. We appreciate your interest in our learning center

*How did you hear about Math Academia?(Required)

Confidentiality Policy

Any and all Information you provide will be kept strictly confidential. Information you provide will help us to better evaluate our students and provide superior teaching methods to facilitate reaching yours and their desired goals.

Student Information:

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone(Required)

Age(Required)

I am fluent in English(Required)

Yes

Educational Data:

What level of education are you currently attending?(Required)

Middle/Junior/High School

College

University

Other

Name of School / College / University institution you are currently attending :(Required)

Grade:(Required)

School / College / University Where You Have Completed Math / English Studies.

1.(Required)

Latest Course Title:

Letter Grade:

Latest Course Title:

Letter Grade:

Parent Information (If Under 18 years of age)

Tell us about yourself. Please print all information legibly

Fathers Name:

First Last

Phone

Mothers Name

First Last

Phone

Emergency Contact

(Who we should contact in case of an emergency)

Name(Required)

First Last

Phone(Required)

I certify that all information

I certify that all information on this form is true and correct to the best of my knowledge. I also understand that I may be required to provide supporting documentation of the information reported.

Applicant’s Signature:(Required)

Date

Parent/ Guardian’s Signature:

Date

Payment and Customer Policies

understand the following policies regarding payment and services set forth by Math Academia.

Private tutoring of Math Academia students (current and prior students for up to three years) by Math Academia tutors is strictly prohibited. Parents may not approach a Math Academia tutor for private hire. Violation of this policy will result in termination of services without refund.
Payment is required before any tutoring services will be rendered.
In the event a check made for tuition payment is returned for “non-sufficient funds,” Math Academia reserves the right to assess a fee of $50.00.
In the event a check made for tuition payment is returned as “account closed,” Math Academia reserves the right to assess a fee of $50.00, and terminate all tutoring services agreed upon herein.

FOR BEST RESULTS, EACH STUDENT SHOULD PRACTICE AND ATTEND ALL TUTORING SESSIONS DECIDED UPON ON THE DAY OF THE REGISTRATION.

Students schedules are agreed upon between Math Academia and parent(s) (where applicable) or between Math Academia and adult students. ACCORDINGLY, Students are expected to attend instructional sessions as scheduled. Since tutors are scheduled as well, failure to attend, absent an emergency or reasonable reason to be absent, may result in an assessment fee.
If a student needs to cancel a private tutoring session, parent/student must notify Math Academia and the assigned tutor at least 8 hours in advance to avoid being charged hourly services.
Payments are NOT refundable for any services (including one-on-one tutoring, group tutoring, summer courses, etc.). Only credits for future services will be issued. Credits are not transferable and will be valid for one year.
Math Academia reserves the right to withdraw services at any time if, in its opinion, a student is failing to meet his / her commitment to arrive on time, complete assigned material(s), or conduct himself / herself in a manner that is inconsistent with Math Academia’s stated code of conduct.