Tutoring Chicago


2019-2020 Returning Student Application
Page 1 of 7 Complete one per child. All information is confidential and will only be shared with Tutoring Chicago staff members and your child's tutor. Tell us about your student!
First Name of Student *
Middle Name of Student
Last Name of Student *
Birth Date *	// (mm/dd/yyyy)
Gender *
Race/Ethnicity	Asian Black or African American Hispanic or Latino White Other
Does your child have any relatives who attend Tutoring Chicago?
Parent/Guardian Information
First Name of Parent/Guardian *
Last Name of Parent/Guardian *
Relationship to Child
Street Address 1 *
Street Address 2
City *
State *
Zip Code *
Email Address *
Primary Phone Number *
Secondary Phone Number
Parent/Guardian Place of Work
Work Phone Number
Primary Language Spoken at Home *	English Spanish English & Spanish Other
Emergency Contact This information must be different than the parent/guardian.
Emergency Contact Name *
Emergency Contact Phone Number *
Emergency Contact Relationship to Child *

Tutoring for Chicago Kids