Website Enrollment Form

Parent Name (First, Last) *

Parent Email *

*This is how you will receive invoices from CLC

Parent Phone *

Preferred Method of Contact *

Call

Email

Mobile

Text

Other

Address Line 1 *

Address Line 2

City *

State/Province

Zip/Postal Code

Country

Student First Name *

Student Last Name *

Student Birthday

How does the student identify racially?

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Middle Eastern or North African

Two or more races

Other

Prefer not to answer

Student Phone

Student Email

School Name *

Student Grade *

Select Your Program(s) *

One on one Tutoring

Math Pods

Literacy Pods

College Readiness

SAT/ACT Prep

Middle School Writing Pod

Home School Enrichment

Tutoring Subjects/Needs *

How would you describe your student’s most recent performance in LANGUAGE ARTS?(If known, please select the level that best matches their most recent test results.) *

Exceeded expectations

Met expectations

Approached expectations

Partially met expectations

Did not yet meet expectations

Not sure / I don’t have this information

Prefer not to share

How would you describe your student’s most recent performance in MATH?(If known, please select the level that best matches their most recent test results.) *

Exceeded expectations

Met expectations

Approached expectations

Partially met expectations

Did not yet meet expectations

Not sure / I don’t have this information

Prefer not to share

Student Learning Supports (Check all that apply) *

Additional Academic Information: Learning Needs, Strengths & Goals

Is there anything else you would like us to know about your student's academics?

Does your family qualify for free or reduced lunch? *

Yes

No

Prefer Not to Disclose

Financial Assistance: *

Yes – I would like to apply for financial assistance. I understand that I must complete a separate Financial Assistance Application and provide any required documentation. Applications are reviewed on a rolling basis and may take up to four (4) weeks to process

No – I do not wish to apply for financial assistance at this time.

What days of the week and time of the day works best for your student? *

Example: Monday 4pm, 5pm or Tues/Thur after 9am

CLC Data & Policies

Can we text you about your student's schedule?

Yes, I agree to the policies in CLC Parents Policies and Guidelines (Required for tutoring)

We respect your privacy and are committed to protecting your information. We collect only what’s needed to provide and improve our services. We do not sell your personal data.

CLC Parent Policies and Guidelines

Photo & Media Release : Throughout the year, Colorado Learning Connections may take photos or videos of students participating in tutoring, enrichment programs, camps, and special events. These images may be used to celebrate student learning and promote our programs through our website, social media, newsletters, annual reports, grant applications, marketing materials, and other publications. Student names will never be published alongside photos without additional permission. *

☐ Yes, I give permission for my child to be photographed and/or recorded and for these images or videos to be used for educational, promotional, and fundraising purposes.

☐ No, I do not give permission for my child to be photographed or recorded for these purposes.

How did you hear about us?

Parent/Guardian Acknowledgment

☑ I certify that the information provided in this enrollment form is true and complete to the best of my knowledge. I have reviewed and understand the policies, permissions, and selections included in this form. I understand that checking this box serves as my electronic signature and has the same legal effect as a handwritten signature.

OPTIONAL: Create an account to save your information and access our online portal!

Login Name

Password

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Status