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Intake/Pre-Assessment Form

Thank you for choosing Inspire Greatness Learning Academy!

This form helps us learn more about your student, their academic strengths, areas for growth, learning preferences, and educational goals. The information you provide allows us to create a personalized learning experience tailored to your child's unique needs.

Please complete this form as accurately as possible before your student's first session. All information provided will remain confidential and will be used solely to support your student's educational success.

We look forward to partnering with you to help your child build confidence, strengthen skills, and achieve greatness!

Parent/Guardian Name

Preferred Method of Communication

Phone

Provide Student name, gender, age, date of birth, grade level, school name

Academic Information: Provide student success and concerns along with subject.

Learning Needs: List IEP, 504, Gifted, Reading or Math Interventions.

Are there any concerns we should be made aware of not previously listed?

File upload- Sample Work Upload if Possible

By signing this document

I certify that the information provided is accurate to the best of my knowledge.
I understand that tutoring services are designed to support academic growth but do not guarantee specific educational outcomes

Signature

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