EGS Application

The information you provide will be kept strictly confidential. It will allow us to quickly assess your needs and follow up with you to schedule or confirm an appointment.

Student Information
First NameLast NameSchoolGrade
Home PhoneCell Phone

Parent / Contact Information
Parent / Contact NameOffice PhoneCell Phone

Academic Information

Academic Needs (eg, Math, Algebra, Geometry, Reading, Spanish)

Availability (eg, only on weekends; after 5)