Enroll

This form is for both enrollment and re-enrollment. It is required for ALL students requesting tutoring. Enrollment is required in order for students to access booking services through the Member's Area. Please allow up to 5 business days for the placement of your student with a tutor at the start of the Fall Semester.

One-on-One tutoring rates begin at $145 per hour.

Student First Name

Student Last Name

Student Email

Student Date of Birth

Month

Day

Year

Guardian Phone Number

By checking this box and submitting this form, you consent to receive SMS text messages from Academic Independence about your child's tutoring sessions and occasional program updates (e.g. group classes or promotions). Message frequency may vary. Message and data rates may apply. Reply STOP to opt out of further messaging and HELP for assistance or call 832-925-7478. Our Privacy Policy can be viewed here: https://www.academicindependence.com/aiprivacypolicy

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email

Student Phone Number

Address

Is this your first time enrolling this student with Academic Independence?

Yes

No

Who is your child's dean/advisor?

We find that open communication between tutor, student, parent, and teacher is beneficial to your child's success. By selecting "Agree" below, you are giving our tutors permission to contact and discuss your child's progress with their teachers.

Agree

Disagree

Enrollment Fee

This is my first time enrolling with Academic Independence for this student.$100

I am re-enrolling my student in tutoring and agree to the re-enrollment fee.$75

TEST PREP FEE: ACT/SAT and ISEE fees include an account to TestInnovators for practice tests and targeted assignments. Please note this fee is for materials only and does NOT include sessions. ISEE sessions are $155 per hour. ACT/SAT are $205 per hour.

One-Time Test Prep. Package (Required if you are requesting ACT/SAT). $450

ISEE Test Prep. Package (Required if you are requesting ISEE)$450

The student is not doing Test Prep. with Academic Independence.$0

Executive Functioning Fee: Please note this fee is for materials only and does NOT include sessions. EF sessions are $155 per hour.

First time enrolling for EF Coaching (Required if you are requesting EF)$300

Re-enrolling for EF Coaching (Required if you are requesting EF)$275

The student is not doing Executive Functioning with Academic Independence.$0

Assessment Fee

The student needs to be assessed for tutoring needs and thinking style.$250

The student does not need consulting for their tutoring needs or thinking style.$0

How did you hear about us?

By signing below, you are agreeing to our policies and giving Academic Independence authorization to charge your credit card on file. Please call the office and provide your credit card information, or you may input the information into our system.

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Enrollment Form

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