SOS4Students - Summer Coaching

Summer Coaching

Welcome,

Complete this intake form to provide information about your student including summer coaching goals. Before you do please review information about the summer coaching process, including pricing and commitment to a 4 session package: https://sos4students.com/wp/summer-coaching

For sessions with Marco, Maggie, Dayna, or Cat- the 4 session package is $860
For sessions with Beth- the 4 session package is $1000

Additional session can be purchased.

After submitting the form, within one business day, you will be able to schedule sessions through our online platform Teachworks. (Existing coaching clients can log in using their existing credentials)

Regards,
Beth Samuelson
Director, SOS4Students

Parent

First Names (Parent 1 & Parent 2)

Last Name (Parent 1 & Parent 2 unless same)

Email (Parent 1)

Email (Parent 2)

Mobile Phone (Parent 1)

Address

City

Address Line 2

State

Other Parent Information

Zip

Credit Card Details

You will be charged for a four-session package.

Cardholder Name

Card number

Student information

Student

First Name

Referred By

Male, Female, Non-binary, Other

Preferred Pronouns

Last Name

School

Grade (1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, College)

Areas of Concern

Challenging Areas

Which Summer School Classes (if any)

Coaching Goals (2-3)

Strengths (academic, social, or otherwise)

Which Subjects are Strengths and Challenges?

Strengths/Challenges for Assignments. Groups? Visual? Essays?

Grades?

How frequently do you check grades?

Usual Bedtime?

Do you wakeup student in the morning?

How often late to school?

Any difficulties with phone, electronic device, social media, video games?

House rules for phone and computer?

Homework Location

Broken Record Conversation

Circumstances or recent events that help us understand needs?

Learning Differences

Yes

School Accommodations? (ie IEP, 504, learning planning)

External Services (Content Tutor, Counselor etc.)

Yes

Evaluations? (e.g. School Testing, Neuropsychological Reports)

Availability Locations

Coaching Availability

Add Fields for Additional Student