Student Application - Tutoring Chicago

Student Application 2023-2024

Complete one application for each student you want to enroll in the program.

Please have the following information ready while completing this application:

Student’s school information
Student’s academic needs
Emergency contact information

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

Tutoring Chicago will serve students in grades 1-10 during the 2023-24 program year. Tutoring Chicago will not accept any new applicant in kindergarten or 11th-12th grade.

Is this application for a new or returning student?

New Returning

Who was this student’s Tutoring Chicago program manager during the 2022-2023 program?

How long has the student been enrolled in Tutoring Chicago?

Parent/Guardian Information

Parent/Guardian First Name

Parent/Guardian Last Name

Relationship to student

Street Address

Tutoring Chicago may occasionally need to mail you items (holiday gifts, tech equipment, books, etc.). Please be sure to include an up to date address with apt/unit # if applicable.

Apartment/Unit #

City

State

Postal Code

Phone

What is the Parent/Guardian’s primary language?

EnglishSpanishOther

What is your child’s primary language?

EnglishSpanishOther

Parent Primary Language

Child’s Primary Language

Are any of the following applicable?

My student receives English Learner Services at schoolMy student is in a dual language or bilingual classroomNone of these apply

Considering your primary language and your student’s language needs, does your student require a tutor that is fluent in Spanish?

Tutoring Chicago recruits Spanish speaking tutors, but cannot at all times accommodate this need

The following information MUST BE DIFFERENT than parent/guardian.

Emergency contact Full Name

First and Last name required

Emergency contact Phone

Relationship to student

Policies

Digital and In-Person Permission:

I understand that Tutoring Chicago is offering both in-person and digital tutoring options during the 2023-2024 school year. I understand that Tutoring Chicago will do its best to accommodate my method, night, and tutor preferences but may not be able to in all cases. I understand that my child will be expected to attend tutoring with their tutor on time – either digitally via Zoom or in person at their assigned location, 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, 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 for my child and that my child may be dismissed at any time. If my child is to remain enrolled, they must consistently attend sessions on time 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 late or absent. I understand that a consistent pattern of absences may result in my child being dismissed from the program.

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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 challenges, social/emotional well-being, and general classroom performance. I agree to share the contact information for my child’s teachers with Tutoring Chicago so that they can obtain the data listed above. 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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Health and Safety

I agree that myself and my child will comply with any health and safety policies and procedures put in place by Tutoring Chicago or our partner facilities. I understand that Tutoring Chicago will make these policies known and available in the parent handbook and in ongoing communication updates that will be sent to me. I understand that Tutoring Chicago will continue to monitor and assess safety risks and follow the guidance of our in-person facilities and local health officials. I understand that if my student becomes ill while at tutoring, I will be contacted and required to pick them up from tutoring.

I agree to inform my program manager if my student is not feeling well and keep them home from tutoring. I understand that if my student is too sick to attend school, they should be kept home from tutoring. I agree to follow all local protocols related to social distancing and quarantine should my child test positive for Covid-19 or any other illness.

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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 parents/guardians wish for their student to meet with their tutor outside of the boundaries of Tutoring Chicago, both parties may agree and consent to doing so, but this arrangement is strictly between the parent/guardian and tutor.

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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Parent/Guardian Handbook

Parents/guardians agree to review the parent/guardian handbook prior to the start of each program year. I agree to adhere to all policies and procedures within this handbook. I understand that Tutoring Chicago updates this handbook on an annual basis.

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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, initial of their last name, and grade, but will not include their full last name or any other identifying information without parent/guardian advanced approval.

I understand and agree to the media releaseI understand and DO NOT agree to the media release

Privacy

Tutoring Chicago’s full 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 on 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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Financial and Legal Information

I certify that all legal and financial information in this application is correct and I can provide verification if requested. I understand that this information is confidential and will only be accessible to Tutoring Chicago staff for the purpose of verifying my child’s eligibility for the program.

Type full first name

Describe your child. This may include their strengths, hobbies, activities, interests, motivations, etc.	What special needs or academic challenges would you consider your child has? Please describe
Does your student have an Individualized Education Program (IEP)? YesNoI don’t knowDecline to answerTutoring Chicago may request documentation regarding your student’s IEP so that we can best serve them. Please be prepared to provide documentation upon request.	If yes, please describe the nature of the IEP – this will be used to best match your student
If yes, please choose which of these best describes your student:	Does your student receive extra support or academic accommodations of any kind in school? Changes in classroom settings (extra time on tests, seating changes)Assistive technology (text-to-speech, calculator or other technology device)School services (speech therapy, occupational therapy, personal aide)Other extra support and/or accommodations (describe in next question)None of these
Please detail the kind of extra support your child receives at school	Does your student have any behavior concerns (not mentioned above) that would be helpful to our staff or the tutor? YesNo
If yes, please describe your student’s behavior:	Based on communications from school, is your student reading at grade level?
What subject does your student need the most help with? MathReading

Student Application 2023-2024

Parent/Guardian Information

The following information MUST BE DIFFERENT than parent/guardian.

School Information

Health Information

Based on your students information, your student is best suited for the SMART Program or may qualify for the LIT Program

Based on your students information, your student is best suited for the Middle School Program

Based on your students information, your student is best suited for the High School Program

Family Financial Information

Policies

Tutoring Chicago is a non-profit, tax-exempt charitable organization under Section 501(c)(3) of the Internal Revenue Code and is a registered non-profit organization in Illinois.

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How did you hear about Tutoring Chicago?	Name of Friend or Family member
Please explain: