Please complete the application form below to register your child for a place on the At Home Tutoring Programme, please read all questions carefully and give us as much information as possible so that we can help your child join the programme ASAP.

If you have any questions about this form or the AHT programme, please contact Bhagirathi.shah@tutorsunited.org who will be happy to help.

MAIN CONTACT DETAILS

Note: Sections marked with an * must be completed in order to submit the form.

Main Parent / Guardian Name*:

Address*:

Borough*:

Postcode*:

Your Email*:

Mobile number*:

Home number:

PUPIL DETAILS

YOUR CHILD - the following questions are about your child:

Name*:

Date of Birth*:

Gender*:

Current Year at School*:

What is the name of your child’s primary school?*

If your child has a disability or learning difficulty please give details here:

If your child has an allergy / health condition that we should be aware of please give details here:

LEARNING PARTNER DETAILS

Have you found a learning Partner for the Programme? (required):

If you answered YES please complete the section below. If you answered NO please tell us whether you are interested in being matched up with another pupil in the area for this Programme and then go straight to the LESSON DETAILS section:

Learning Partner / Guardian Name:

Address:

Borough:

Postcode:

Email:

Mobile number:

Home number:

LEARNING PARTNER CHILD DETAILS - the following questions are about your learning partner child (if you have found one):

Name:

Date of Birth:

Gender:

Current Year at School:

What is the name of your learning partner's primary school? (required)

If your learning partner has a disability or learning difficulty please give details here:

If your learning partner has an allergy / health condition that we should be aware of please give details here:

LESSON DETAILS

What subject would you like your child(ren) to study?*

What days are suitable for your private tutoring lesson? Note sessions are run between 3:30 – 6:00pm. Please select all suitable days*:
 Monday Tuesday Wednesday Thursday Friday

Please provide us with a preferred time indication for your tutoring lesson (1 hour sessions e.g. 4:30 – 5:30 pm)*:

PROGRAMME ELIGIBILTY

Is your child eligible for free school meals?*:

Are you or your child a 1st or 2nd generation migrant in the UK?*:

Are you eligible for housing benefit, council tax support or working tax credit?*:

Is your household income under £30,000 a year?*:

Is your child a BME (Black or Minority Ethnic) pupil?*:

PARENTAL CONSENT

From time to time Tutors United will use footage and photographs of their lesson in promotional videos or materials, do you give permission for Tutors United to video or take pictures of your child for this purpose?*:

ADDITIONAL INFORMATION

Why should your child be enrolled into the Programme?*:

What would you like to see as a result of your child’s participation in this Programme?*:

How will this Programme help your child?*:

If there is anything else you would like to add in order to support your application please tell us here:

MONITORING DIVERSITY

We monitor the diversity of our pupils in order to make sure we are providing our services primarily to pupils from low income and migrant backgrounds. Your answers will be kept confidential.

What is your child's ethnic origin? Please select one answer or check the 'Prefer not to say' option*:

COMMUNICATION

How did you hear about us?*: