Application for Math Clinic Tutoring

1. Child’s full name

2. Child’s school and district

3. Current grade

4. Child’s birthday

5. Current age

6. Language(s) spoken at home

7. Child’s home address

8. Mother's name

9. Mother’s address: (if different from above)

10. Mother’s phone numbers (cell, home, work) and email:

11. Mother’s language(s)

12. Father's name

13. Father’s address: (if different from above)

14. Father’s phone numbers (cell, home, work) and email

15. Father’s language(s)

16. Emergency contact (someone besides a parent)

17. Emergency contact's relation to child

18. Contact’s phone numbers (cell, home, work)

19. Please describe your child’s difficulties in math

20. How do you think your child learns best?

21. Does anyone else in your family struggle from a difficulty with math or reading? Please describe.

22.

PARENT/ GUARDIAN CONTRACT

I will encourage and support my child for the duration of the Gordon Math Clinic program.  My child will attend all tutoring sessions that he/ she is assigned.  I will make myself available for teacher contact or conferences, and I will not hesitate to contact my child’s teacher if I have any questions or concerns.

23.

With my permission, periodic tutoring sessions will be recorded to ensure fidelity of implementation by the graduate student. My child’s face will not be in the video.

24.

I permit another graduate student in the Math Specialist program to watch my child’s video - for the purposes of peer feedback. The graduate student will be giving feedback on the tutor’s performance (not critiquing your child’s performance).

25. I give the math clinic tutor permission to contact my child's current teacher(s) to plan educational goals for them as well as to request academic records and supplemental materials for activities during tutoring sessions.

26.

Math Clinic Policies

• Regular attendance is critical to ensure your child makes progress and gains momentum with learning.
• Your tutor is finishing their degree and plans on graduating. He/she must tutor at least two children for a combined total of 100 hours. Excessive absences and tardiness will make it difficult for them to graduate on time.
• A professor will observe your tutor 10 times throughout the year. This is to help support their development as a reading teacher. He/she will be graded on these lessons. It is critical that your child be present for these observation lessons. You will be updated when these dates are scheduled.
• If you must cancel or are running late, call or text the tutor directly.
• Sickness, family emergency, and car trouble are typical reasons for needing to cancel. Please miss no more than 3 sessions this year. Your tutor might occasionally need to cancel because of his/her own family or school related reasons.
• We follow the MA Public Schools’ vacation calendar.

I have read and understood the Math Clinic Policies.