ONLINE ACADEMIC SUPPORT and
ENHANCEMENT CLASS APPLICATION
FORM
A. PERSONAL INFORMATION
1. Full Name: _______________________________________
2. Nickname (if any): _________________________________
3. Age: _______
4. Date of Birth: _______________
5. Gender: [ ] Male [ ] Female [ ] Prefer not to say
B. CONTACT INFORMATION
6. Email Address: ___________________________________
7. Mobile Number: __________________________________
8. Address: _________________________________________
_________________________________________________
C. PARENT/GUARDIAN INFORMATION (For Minors)
9. Full Name of Parent/Guardian: _______________________
10. Relationship to Student: ___________________________
11. Contact Number: __________________________________
12. Email Address: ____________________________________
D. ACADEMIC INFORMATION
13. Current Grade Level/Year: ___________________________
14. School Name: _____________________________________
15. Preferred Subjects for Tutorial (check all that apply):
[ ] English [ ] Math [ ] Science [ ] Reading
[ ] Grammar & Composition [ ] Other: __________________
E. SCHEDULE PREFERENCE
16. Preferred Days: [ ] Monday [ ] Tuesday [ ] Wednesday [ ] Thursday [ ] Friday [ ] Saturday
[ ] Sunday
17. Preferred Time: [ ] Morning [ ] Afternoon [ ] Evening
Specific Time: ___________________________
F. TECHNOLOGY & INTERNET ACCESS
18. Do you have a stable internet connection? [ ] Yes [ ] No
19. Device to be used: [ ] Desktop Computer [ ] Laptop [ ] Tablet [ ] Smartphone
G. TUTORIAL FEE AND PAYMENT TERMS
20. Professional Fee of the Tutor: Php __________ per hour/session
21. Payment Method: [ ] GCash [ ] Bank Transfer [ ] Others: __________________
22. Payment Schedule: [ ] Weekly [ ] Biweekly [ ] Monthly
H. STUDENT COMMITMENT CLAUSE
I, the student (or parent/guardian for minors), understand that this tutorial is an academic
support service aimed at improving performance and learning skills. I therefore commit to:
- Attending sessions regularly and on time
- Being prepared and submitting assignments
- Respecting the tutor and the learning process
- Actively participating in class
- Striving for academic excellence with integrity
Signature of Student: _________________________ Date: _______________
I. ADDITIONAL CONCERNS / SPECIAL NEEDS
23. Please indicate any learning difficulties, health conditions, or other matters the tutor
should be aware of:
___________________________________________________
___________________________________________________
J. CONSENT AND CONFIRMATION
[ ] I confirm that all the information provided is true and correct.
[ ] I agree to the terms of payment and the student commitment clause.
[ ] I understand that non-compliance with the agreed schedule and expectations may affect
the outcome of the tutorial.
Name of Applicant or Parent/Guardian (for minors): ___________________________
Signature: ___________________________ Date: ___________________
