SMART Application - Tutoring Chicago

Complete one application per child.

Please have the following information ready while completing this application:

Student’s school information
Student’s academic needs
Family financial information
Emergency Contact information

During the 2021-2022 school year, Tutoring Chicago will offer in-person or digital tutoring options to students. Within this application you will have an opportunity to tell us more about your student’s needs and preferences. Our staff will do our best to accommodate the preferences of our students, but in some cases we may not be able to accommodate all preferences due to limited capacity of physical space or volunteer availability.

If your student is applying to Tutoring Chicago for the first time, they must be in 1st-6th grade. Tutoring Chicago will not accept any new applicants in 7th or 8th grade. If your student was in Tutoring Chicago programming at any point in 2020-2021 as a 6th or 7th grader, they may apply as a returning student for our middle school program, serving 7th and 8th graders.

Is this application for a new or returning student?

New Returning

Who was this student’s Tutoring Chicago Site Manager during the 2020-2021 program?

Policies

Read and initial each statement. Write “N/A” if you do not consent.

Digital and In-Person Permission:

I understand that Tutoring Chicago is offering both in-person and digital tutoring options during the 2021-2022 school year. I understand that Tutoring Chicago will do its best to accommodate my preferences but may not be able to in all cases. I understand that my child will be expected to connect on time either digitally via Zoom or in-person at one of our two locations with their assigned tutor, working on academic enrichment once a week.

I recognize that Tutoring Chicago will provide a schedule, guidance, resources and best practices for these sessions. I understand that it is my responsibility as a parent/guardian to supervise and facilitate any digital contact between my child and their tutor (video-conferencing, emails, facetime, phone-calls, texts, etc).

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General Permission

I give permission for my child to be enrolled in the Tutoring Chicago program. I understand the program is a service to my child and that my child may be dismissed at any time. If my child is to remain enrolled, he or she must attend each session and follow the rules. I understand that attendance is essential to my child’s improvement. I will inform the tutor and a Tutoring Chicago staff member if my child is going to be absent. I recognize that tutoring is a resource not to be taken away as a form of punishment.

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Academic Data

I permit Tutoring Chicago and my child’s tutor to contact my child’s school, teacher(s), counselor(s), administration, and/or school system to attain specific information about my child’s academic performance and needs including, but not limited to, report card grades, standardized test scores, homework scores, academic strengths and weaknesses, social/emotional well-being, and general classroom performance. I understand that this information may be shared with my child’s tutor in order to aid the learning process. I understand that this information will be housed in Tutoring Chicago’s database and viewable by Tutoring Chicago staff and third party consultants for data analysis purposes.

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Medical Emergency

In the event of a medical emergency, I grant permission for my child to be transferred to a medical facility for treatment and receive the treatment deemed necessary by the qualified medical staff at that site. I will be responsible for all costs incurred with such treatment(s). I understand that in the event of such an emergency, Tutoring Chicago will make all reasonable attempts to contact the parent/guardian or emergency contact I have listed on this application. In consideration of being permitted to participate, I do hereby waive and release Tutoring Chicago and all affiliates, directors, employees and volunteers from any and all claims for injuries, including death, damages, property damage, or loss which may occur on account of participation in the tutoring program, including field trips and special events.

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Off-site Contact TUTORING CHICAGO neither encourages nor endorses in-person, off-site independent contact and activities between students and tutors. If such relationships and/or activities are to take place independent of a tutoring session, TUTORING CHICAGO is not responsible for accidents and/or incidents arising from such events.

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Media Release I permit Tutoring Chicago to use any photographs or video footage featuring my child or any artwork, writings, or media statements taken or created in connection with the program for any type of publicity or fundraising without requiring further approval. I understand that Tutoring Chicago may publicize my child’s first name and grade, but will not include their last name or any other identifying information without parent/guardian advanced approval.

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Privacy Tutoring Chicago’s privacy policy can be viewed here. I permit and understand the following privacy policies as it relates to information I submitted in this application:

Tutoring Chicago will share necessary information with my child’s tutor including; name, age, grade, gender, parent/guardian phone and email as well as any information contained on the school information page of this application.
Tutoring Chicago will print my child’s allergies and/or asthma condition on his/her/their nightly name tag for my child’s health and safety. Any additional information I shared about my child’s health may be shared in confidence with my child’s tutor but will not be displayed on a name tag.
All other information contained within this application is considered confidential and will only be accessible to Tutoring Chicago staff.

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I certify that all legal and financial information in this application is correct and I can provide verification if requested.

Type full first name

First Name	Preferred Name/nickname
Last Name	Date of Birth (MM/DD/YYYY)
Gender FemaleMaleNon-binary/third genderPrefer to self describePrefer not to say	Self described gender:
Pronoun He/Him/HisShe/Her/HersThey/Them/Theirs	Race/Ethnicity Asian AmericanBlack or African American Hispanic/LatinxWhiteOthercheck all that apply
Does your student have any relatives who have attended Tutoring Chicago in the past? YesNo	If yes, who?
How did you hear about Tutoring Chicago? Name of Friend or Family member Please explain:

Student Application 2021-2022

Parent/Guardian Information

The following information MUST BE DIFFERENT than parent/guardian.

School Information

Health Information

Family Financial Information

Policies

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