Enrollment Inquiry

(This form is to be completed at the PEL center.)

Enrollment Inquiry Form

This field is for validation purposes and should be left unchanged.

New Student or Transfer Student?(Required)

Please Select PEL Learning Center(Required)

Subject(s) / Service(s)

Math

English

Summer Workshops

After School Homework Help

Private Tutoring

1st Child's Information

Child's Name - Child 1(Required)

First Middle Last

Age - Child 1

Date of Birth - Child 1(Required)

Gender - Child 1

Grade - Child 1(Required)

School - Child 1

Do you need to add a 2nd child?(Required)

Yes

2nd Child's Information (if necessary)

Child's Name - Child 2

First Middle Last

Age - Child 2

Date of Birth - Child 2

Gender - Child 2

Grade - Child 2

School - Child 2

Do you need to add a 3rd child?

Yes

Child's Name - Child 3

First Middle Last

Age - Child 3

Date of Birth - Child 3

Gender - Child 3

Grade - Child 3

School - Child 3

1st Parent Information

1st Parent's Name(Required)

First Last

1st Parent Email Address(Required)

1st Parent Occupation

Home Address

Street Address City State / Province / Region ZIP / Postal Code

1st Parent Home Phone

1st Parent Cell Phone(Required)

1st Parent - I consent to receive SMS text messages and phone calls from PEL.(Required)

Yes

2nd Parent Information

2nd Parent's Name

First Last

2nd Parent Email Address

2nd Parent Occupation

2nd Parent Home Phone

2nd Parent Cell Phone

2nd Parent - I consent to receive SMS text messages and phone calls from PEL.

Yes

In Case of Emergency

Guardian's Name

First Last

Phone

Medical Concern(s):

Survey

How Did You Learn about PEL Learning Center?

Who referred you?

Special Concerns

Parents: To help us understand and guide your child optimally, check one or more of the tutoring categories below.

Please choose all applicable answers. Each choice will add additional questions below.

My child needs:(Required)

Remedial Services (My children are falling behind)

Enrichment Services (I need my children to be challenged more)

Early Learner Assistance (My children are in pre-school or kindergarten)

A. Remedial Services

Please choose all applicable answers.

How long has your child been struggling with Math/English Language Arts?

Less than 3 months

3 months to 1 year

more than 1 year

Why do you think that he/she is struggling with the subject(s)?

Covid-19 learning loss

summer vacation learning loss

Frequent substitute teachers

Other:

Please explain why you choose Other:

How much time does your child spend on homework each day?

Less than 1 hour

1 – 2 hours

2 – 3 hours

More than 3 hours

How confident is your child in school? (10 being extremely confident)

What special attention(s) is your child getting in school?

IEP

Special Needs

No special attention

Other

Please explain why you choose Other:

What are some things you wish his/her teacher would do to help?

Does your child demonstrate anxiety when he/she comes to taking tests?

Yes

Do you think it is possible for your child to be studying in advanced materials in approximately one to two years?

Yes

B. Enrichment Services

Please choose all applicable answers.

How does your child typically perform in Math/English Language Arts tests?

Below 80 percentile

80 to 90 percentile

Above 90 percentile

How much time does your child spend on homework each day?

Less than 1 hour

1 – 2 hours

2 – 3 hours

More than 3 hours

Do you think that your child could achieve more if he/she is exposed to more advanced study materials?

Yes

Maybe

Do you know whether your son’s/daughter’s school develops strong math/reading comprehension skills?

Yes

Maybe

Is your child being challenged academically in class?

Yes

Maybe

Does he/she have a hard time staying engaged in class?

Yes

Maybe

C. Early Learner Assistance

Please choose all applicable answers.

What is your primary reason for seeking an early learning program for your child?

Foundation for all future learning and well-being

Develop independence and self-reliance

Socialization

Other

Please explain why you choose Other:

How often do you read to your child on a regular basis?

Daily

Frequently

Occasionally

Rarely

Does he/she like books?

Yes

Only books that interest my child

When your child reads, does he/she read with good comprehension or mechanical in nature?

Comprehension

Mechanical

How often do you practice counting with your child?

Daily

Frequently

Occasionally

Rarely

Does he/she enjoy numbers/math?

Yes

Depends on how he/she feels

Are you satisfied with his/her motor skills at this age, or would you like to see it more developed?

I am satisfied

It can be more developed

Do you think it is possible for your child to be studying high school level material while still in grade school?

Yes

Do not know