Ebata L.U.M.A. Studio

Inclusive Tutoring for Every Learner
Different Learners. One Purpose. Personalized Support. Proven Achievement.
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Parent/Guardian Intake Form

Help us understand your child so we can build the right learning plan — together.

Primary Pillar For This Form
L · Learner-Centered
U · Uplifting
M · Measurable
A · Achievement
A

Section A — Student Information

B

Section B — Parent/Guardian Information

C

Section C — Reason for Seeking Tutoring

D

Section D — Reading Needs

Check all that apply:

E

Section E — Writing Needs

Check all that apply:

F

Section F — Academic Background

G

Section G — Goals & Vision of Success M · Measurable

H

Section H — Signature & Acknowledgment

"I confirm the information above is accurate and consent to Ebata L.U.M.A. Studio using it to design my child's personalized tutoring plan."

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