Student 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

Due to the uncertainty created by the COVID-19 outbreak and current limitations to gathering in large groups, Tutoring Chicago has decided to start the 2020-2021 program year 100% digital. We will continue to monitor the situation and stay in accordance with local guidelines for group gatherings.

It is our hope and expectation that we will continue in-person tutoring as soon as is safe and allowable.

Policies

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

Digital Permission during COVID-19

Due to the need to practice social distancing in relation to the Covid-19 outbreak, I understand that the Tutoring Chicago program will start off as a digital program in the fall of 2020. I understand this means that my child will be expected to connect digitally with his/her assigned tutor through video conferencing, working on academic enrichment on a weekly basis until the in-person tutoring program can resume.

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).

I understand that tutor and student contact should be limited to their tutoring sessions. No connections or communications should take place in-person until facilitated by Tutoring Chicago.

I understand that once the in-person tutoring program resumes, that my child is expected to attend weekly tutoring sessions at their assigned site on their assigned night.

Initial Here

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.

Initial Here

Academic Data

I permit Tutoring Chicago and my child's tutor to contact my child's school, teacher(s), 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.

Initial Here

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.

Initial Here

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 Tutoring Chicago will not publicize my child’s name without parent/guardian advanced approval.

Initial Here

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.

Initial Here

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 on his/her 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.

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

Type full first name

Student Application 2020-2021

Parent/Guardian Information

The following information MUST BE DIFFERENT than parent/guardian.

School Information

Health Information

Family Financial Information

Policies

Subscribe to our newsletter!