Fall Semester 2020: Tutoring Registration Form

This registration form can be used for all one-on-one tutoring programs at Illini Tutoring. We MUST have this form on file for every student.

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Logo of Empowered Learning, formerly Illini Tutoring

Fill out this form for ONE-ON-ONE tutoring only.

If you are signing up for group tutoring, please fill out the GROUP TUTORING form.

Student's Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

We only need the name they go by, not their full/legal name.

How do you pronounce the student's first name? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Who is responsible for tutoring payments? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Name of person responsible for payment {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

If you are 18 years or older and you are paying for your own tutoring, please enter your name.

Email address for the person listed above {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Please double-check that you've entered the correct email address.

Parent/guardian's Email (if paying party is not the parent/guardian) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Parent/guardian's Phone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Student's Phone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Student's Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Student's Birthday {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Has the student ever been diagnosed with any of the following? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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All students are welcome at Illini Tutoring. We ask this question because we can customize the student's tutoring plan and provide suitable learning strategies for each unique student.

Student's Mailing Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Emergency Contact Info

If there's ever an emergency while this student is at Empowered Learning, we will automatically try to call the parent/guardian listed above FIRST. If we cannot reach that person, we will call the emergency contact listed below. We will not contact this person regarding scheduling, payment, etc.

Emergency Contact Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

This line must be different from the parent listed above.

Emergency Contact Relationship to Student {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Emergency Contact Phone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

This is who we will call if your child has an emergency at Empowered Learning and we cannot reach the parent. We will not contact this person for any other reason.

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	Not preferred	Preferred	Strongly preferred	N/A
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Selecting a Test Prep Package

The package of hours you select must be completed by the student's goal test date.

Do you want to register for additional hours for a different test prep date? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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SAT Subject Test

We offer 12-hour packages for SAT Subject Test Prep. However, you can add additional hours or purchase multiple 12 hour packages. We do not have registration deadlines for SAT Subject Test prep, though you should plan on coming to tutoring 2-3 times a week for 4-6 weeks leading up to your SAT Subject Test. We encourage you to call or email us to confirm our availability before registering for SAT Subject Test prep!

Additional Tests {binding ItemNumber}

Sunday Availability {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Select every time student can be scheduled for tutoring.

Monday Availability {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Select every time student can be scheduled for tutoring.

Tuesday Availability {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Select every time student can be scheduled for tutoring.

Wednesday Availability {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Select every time student can be scheduled for tutoring.

Thursday Availability {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Select every time student can be scheduled for tutoring.

Preferred Times and Days {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Known Conflicts with times selected above {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Agreement: Student's Availability

I have selected all times that the student could be scheduled for Test Prep tutoring. I understand that there is no guarantee that my preferred times can be honored. I understand that Empowered Learning will email me a list of all scheduled Test Prep tutoring times leading up to my student's goal test date. I agree to review the Schedule Confirmation within 48 hours of receiving this Schedule Confirmation email, and I agree to notify Empowered Learning within that 48 hours if there are any times that won't work (times that must be rescheduled). If a tutoring time was scheduled outside of the availability I selected above, Empowered Learning will reschedule the time ONCE. If I request more than 2 tutoring sessions to be rescheduled, which are scheduled within the availability I selected above, I will be charged a $25 administrative fee to reschedule these times.

I understand that beyond this 48 hour time frame, I must reschedule each tutoring session using the Reschedule Request form (whether the tutoring hours were scheduled according to the availability I selected above or not), and I agree to follow the rescheduling rules.

I have read the above Availability Agreement Statement, and I agree to all parts of it. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Do not submit this form if you do not agree to this statement.

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Consent and Agreement Page

Consent to Work with a Tutor

I certify that I am the parent or legal guardian of the child whom I am registering for tutoring through Illini Tutoring, or that I am the student and I am 18 years or older. I am giving permission for my child, or I am giving my own consent, herein referred to as "the student," to work one-on-one with a tutor at 2500 Galen Drive, or at another public location or online using Google Hangouts should circumstances arise that preclude holding a tutoring session at 2500 Galen Drive. I understand that parents are not required to remain in the building during their child's tutoring sessions, but it is highly recommended that I stay if the student is 13 years old or younger. I understand that it is my responsibility to have the student at the Illini Tutoring office ready to start his/her tutoring session on time. I understand that Illini Tutoring can make no guarantees with regards to test scores and grade improvement, and I will not hold the company, the owners, the employees, or any agents of Illini Tutoring responsible in the event that my child does not benefit from the services provided. I understand that Illini Tutoring does not offer full or partial refunds for unused tutoring except when Illini Tutoring deems it necessary to discontinue tutoring with a student. I agree to read the Welcome Packet in its entirety upon receipt, which outlines procedures for rescheduling and conflict resolution.

Rescheduling Policy

Illini Tutoring serves hundreds of students each year and our scheduling is often very tight, especially around exam times. We require our students to provide no less than 24 hours notice if they will miss a tutoring, coaching, or test prep session. Students who provide sufficient notice can have their one-on-one hour rescheduled to another time within seven (7) days. Students who forget their tutoring session or who provide less than 24 hours notice are welcome to make up their time during a Make Up Tutoring Hour. Students who reschedule their tutoring time 2 or more times per trimester semester, regardless of the amount of notice given, may be asked to choose a new tutoring time. Test Prep students may only reschedule one tutoring session per month, even if more than 24 hours notice is given. We cannot guarantee that your child will be able to meet with his or her regular tutor if you must reschedule. If we are unable to reschedule a tutoring session because you have very limited availability or availability outside of our regular tutoring times, we will not reschedule your session and it will be forfeited.

Trimester Commitment

Math & Science Tutoring and Academic Coaching students agree to pay for their entire trimester of tutoring. They may increase their tutoring plan, but they may not decrease their tutoring plan until the following trimester.

On-Time Payment Policy

Math & Science Tutoring and Academic Coaching students agree to pay for their tutoring in one lump sum or they agree to pay in equal monthly payments, which are due on the 1st of each month. Payment in full is due, even if the student chooses to discontinue tutoring.

Test Prep Students agree to pay for their package in one lump sum or they agree to pay in equal monthly payments, which are due on the 1st and 15th of each month. Payment in full is due, even if the student chooses to discontinue tutoring.

Illini Tutoring LLC will charge a late fee of $25 when the paying party is more than two (2) weeks late making the minimum payment due. Illini Tutoring LLC will pursue legal action if clients fail to pay for the tutoring services outlined in the contract above.

Any exception to any term in this contract must not be construed to mean the contract is null and void. All terms of the contract will be enforced through the end of the student's tutoring package, as stated in this contract.

Policy Against Unlawful Harassment, Discrimination, and Retaliation

Illini Tutoring LLC is committed to providing a work- and learning environment free of sexual or any other form of unlawful harassment or discrimination. Illini Tutoring LLC has a no-tolerance policy, and is committed to maintaining a respectful, courteous work and learning environment in all work- related settings that respects the dignity and worth of each employee and student. Inappropriate behavior and unlawful harassment are wholly inconsistent with this commitment. No employee, client, parent, student, vendor or other person who does business with Illini Tutoring LLC is exempt from the prohibitions within this policy.

Harassment or discrimination based on race, color, ethnicity, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), gender (including gender identity and gender expression), religion (including religious dress and grooming practices), religious creed, marital status, age, national origin, ancestry, citizenship, physical or mental disability, military and veteran status, genetic information, medical condition (including cancer and genetic characteristics), sexual orientation, or any other protected class, characteristic, or consideration made unlawful under applicable federal, state, or local laws, is illegal and prohibited by Illini Tutoring LLC policy. Such conduct by or toward any employee, client, parent, student, vendor or anyone else who does business with the Company will not be tolerated.

We believe that the strength of Illini Tutoring LLC is found in the diversity of our staff and our students. We actively employ and serve people from diverse backgrounds. Our employees and subcontractors receive ongoing training on cultural competency and creating an inclusive atmosphere that is respectful of all people.

When a client (student or parent) is found to be harassing, bullying, or intimidating another student, parent, or employee of Illini Tutoring LLC, we reserve the right to immediately terminate this contract and discontinue providing services to the student and/or the parent. We may refund a portion of the student's tutoring payments for unused tutoring that would be canceled. If a refund is given, the maximum refund given will exclude the non-refundable $150 deposit payment.

Prohibited Conduct

Sexual or other unlawful harassment or discrimination includes any verbal, physical, or visual conduct based on sex, race, age, national origin, disability or any other legally protected basis if:

submission to such conduct is made either explicitly or implicitly a term or condition of an individual’s employment or engagement with Illini Tutoring LLC;
submission to or rejection of such conduct by an individual is used as a basis for decisions concerning that individual’s employment or engagement with Illini Tutoring LLC; or
it creates a hostile or offensive work environment.

Sexual harassment includes unwelcome sexual advances, requests for sexual favors, and lewd, vulgar, or obscene remarks, jokes, posters, or cartoons, and any unwelcome touching, pinching, or other physical contact. Other forms of unlawful harassment or discrimination may include racial epithets, slurs, and derogatory remarks, stereotypes, jokes, posters, or cartoons based on race, national origin, age, disability, marital status, or other legally protected categories. Prohibited harassment also includes the transmission of materials such as cartoons, jokes, or links to offensive materials online using the Illini Tutoring LLC’s electronic communications system, or through other online conduct.

Treating any employee or individual differently or unfairly because of the characteristics listed above is also prohibited. Unlawful discrimination includes conduct that is based on the perception that anyone has any of those characteristics, or is associated with a person who has or is perceived as having any of those characteristics. All Illini Tutoring LLC employees, other workers, and representatives are prohibited from engaging in unlawful discrimination.

Test Prep Agreement

Test Prep students will receive an availability form after the registration deadline for their Test Prep package (this is usually on the 15th of the month prior to the start of tutoring.) Students will have 48 hours to submit their availability for the upcoming month after receiving this form. Our scheduling coordinator will then schedule all Test Prep students based on their availability. We will then send each Test Prep student their full tutoring schedule. If you receive your schedule and we've made a mistake, we will fix it. However, if you receive your schedule and you have been scheduled at a time that no longer works, we will attempt to reschedule your student one more time. Parents who don't fill out these forms by the deadline may lose their Test Prep spot. We do not offer refunds in these situations.

After receiving their schedule, Test Prep students are allowed one reschedule per student each month. We must receive a reschedule request at least 24 hours in advance. Students who do not stick to their carefully formulated Test Prep plan and schedule will not be able to reach their goals. Test Prep is a short term commitment that requires complete dedication, and because of the costs and seriousness of these tests, we have strict guidelines for scheduling and rescheduling.

You must agree to the following: I will ensure that my child (or, the student) prioritizes Test Prep tutoring for the duration of their tutoring program. I understand that I will receive my student's complete schedule the month prior to their start date (or shortly after registration, in the case of late registration.) I agree not to schedule other appointments during these tutoring hours and I will ensure that my student will not miss or reschedule Test Prep tutoring sessions because of other extracurricular activities, such as sports practices, musical rehearsals, band rehearsals, afterschool clubs, excessive homework or projects, and other activities. I will inform my child's coaches and directors, if necessary, that my student will not be able to attend last-minute practices, meets, or performances if they conflict with Test Prep tutoring. If my student does choose to attend these other activities instead of Test Prep, I understand that these sessions cannot be made up unless I use my single reschedule allowance each month (and I understand I still must give at least 24 hours notice to be able to make this time up). I understand that Illini Tutoring may grant exceptions in extreme situations, such as serious illness or a death in the family, but I will need to provide a doctor's note or other sufficient proof that my student needs to miss Test Prep tutoring for a reason outside of our control. I understand that my student will need to meet with another tutor, if times are available, should I request any last minute reschedules or more than one reschedule. I understand that failing to complete Test Prep homework is not an excuse to miss Test Prep tutoring, so even if my student fails to complete his/her homework for any reason, he/she will still go to tutoring. I will receive my child's Test Prep tutoring scheduling for the entire upcoming month on Schedule Release Day (the Friday or Saturday after each cycle's registration deadline). I will review this schedule and report any errors within two days. I understand that I may reschedule ONE tutoring session per month with Taso. I understand that I need to reschedule this session at least 24 hours in advance. If I do not provide at least 24 hours notice, I understand the session will not be rescheduled one-on-one but my student can attend a make-up hour instead. If I reschedule more than one tutoring session in a month, regardless of the amount of notice given, I understand that this session cannot be rescheduled. I understand that it is my responsibility to make sure my student attends his/her scheduled tutoring sessions with Taso, and if we do choose to reschedule or miss sessions, I understand that there may be no opportunities to reschedule these sessions before my child's test date.

I understand that Test Prep tutoring can continue after the student's Test Date as long as the student is re-enrolled. However, I understand that after the registration deadline, I cannot pause tutoring or cancel enrollment. (Illini Tutoring may make exceptions in serious situations, such as extreme illness, family crisis, death in the family, and so on.) If we need to pause our tutoring due to a serious illness, I will inform Taso in writing of this need and we will work together to determine the next start date so that my child can complete the remaining hours in his/her tutoring package.

I give consent for tutoring and I agree to follow the policies above. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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I agree to all terms in the Test Prep Agreement. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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I understand the $250 deposit cannot be refunded unless the program I'm registering for is not available. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Paying by check or cash? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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If you wish to pay by check or cash, you will need to mail or bring a check to our office before you can submit this form.

Instructions for Paying by Check or Cash

If you wish to pay by check or cash, you will need to mail or bring a check to our office before you can submit this form. (Do NOT mail cash!)

1.) Please SAVE your form and submit your payment.

2.) After we receive your payment, we will email you a code to enter below and you will be able to submit your registration. If you are filling out this form in our office, please give your payment to a tutor and the tutor will give you the code right away.

3.) Please note that we do not process registration forms until we receive payment. The tutoring times or programs you've selected may not be available by the time we receive your payment if you choose not to pay by credit card below.

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Promotional Code (Optional) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Discounts and credits, when applicable, will be reflected on your next invoice. Discounts and credits may not be applied to the non-refundable deposit.

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Fall Semester 2020: Tutoring Registration Form

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Logo of Empowered Learning, formerly Illini Tutoring

Fill out this form for ONE-ON-ONE tutoring only.

If you are signing up for group tutoring, please fill out the GROUP TUTORING form.

Student's Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Who is responsible for tutoring payments? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Parent/guardian's Email (if paying party is not the parent/guardian) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Parent/guardian's Phone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Student's Mailing Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Emergency Contact Info

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Semester Tutoring Plans and Tuition

Fall Semester Rates and Information

Students can register at any time during the school year, even in the middle of a semester. Your total will be pro-rated.

These rates are for the entire Fall Semester (August 30 - December 18) for tutoring hours scheduled Sunday-Thursday. There is NO TUTORING November 22-27 (students are not billed for this week.)

There is an additional charge of $10/Sunday for sessions scheduled on Sundays.

The rates shown below are the TOTAL cost for an ENTIRE SEMESTER.

There is a discount for paying for the entire semester at registration.

Alternatively, families can choose to pay a $250 deposit toward their tutoring program and pay monthly installments. These monthly installments will be through a PayPal subscription, and your payment will be automatically charged to your credit/debit card each month. There is an additional $25 fee to pay by monthly installment.

Students who have conflicts with these dates are able to reschedule their tutoring for no additional cost if they submit a Reschedule Request form at least 24 hours in advance.

We've created this schedule so that there are 15 of each tutoring day, for every academic tutoring student. (15 Sundays, 15 Mondays, 15 Tuesdays, 15 Wednesdays, 15 Thursdays)

Fall Semester Tuition

Students can register at any time during the semester until our rosters are full. Students who register after the start of the Fall Semester will pay a pro-rated total, but not less than half of the semester's cost. If students register after the half-way point in the semester (after October 24), they will pay exactly half the tuition for their total, regardless of how many tutoring sessions remain in the semester.

Honors: 15 sessions @ $70/hour
($1050 total. 4 monthly installments @ $200/month. Pay in full discount: $950)

Scholar: 30 sessions @ $66/hour
($1980 total. 4 monthly installments @ $432.50/month. Pay in full discount: $1800)

Elite: 45 sessions @ $63/hour
($2835 total. 4 monthly installments @ $646.25/month. Pay in full discount: $2675)

Premier : 60 sessions @ $61/hour
($3660 total. 4 monthly installments @ $852.50/month. Pay in full discount: $3450)

Tutoring Subjects

Please choose the subjects the student needs tutoring in below.

Choose Tutoring Subjects

Additional Classes from Same Category {binding ItemNumber}

*Enrichment Math (Optional) If your 4th-8th grader needs an extra challenge in math, we offer a math enrichment program called Art of Problem Solving. This is a rigorous math program that advanced math students really enjoy! There is an additional cost for Art of Problem Solving books. We will assess your child at their first tutoring session to determine which Art of Problem Solving level is appropriate for them, and then we'll provide the right books. A set of books ranges from $30-$70, and most students complete a book in 6 months. Math enrichment students can also use some of their tutoring time to ask questions about school homework and to study for tests.

One-on-One Scheduling: Tutor Preferences and Availability

Math, science & writing (academic) one-on-one tutoring students meet with the same tutor on a regular schedule.

Please indicate your preferred tutoring times below. Whenever you have an occasional conflict, you'll be able to reschedule tutoring sessions if you complete a Reschedule Request form at least 24 hours in advance.

If you aren't sure which tutor to choose (we are all a great choice, you just can't go wrong!), read our tutors' bios at our Tutor Bio page! If a student starts working with a tutor and it's just not a great fit, please email us and we'll solve the problem together.

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Student Availability

Please check *every single hour* below that the student is available to come to Illini Tutoring.

Not all tutors are available at all the hours listed below. We strongly encourage you to choose all available hours!

Indicate your scheduling preferences in the text box below.

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Academic Tutoring (monthly installments)

The rates shown below include a $250 deposit (this will be applied to the tutoring program you select) AND a $25 administrative fee (this covers our expenses for accepting monthly installments. This fee will not be applied to your tuition balance.)

Elizabeth and Taso are the owners of Empowered Learning. They train and oversee every instructor. There is an additional fee to work with Elizabeth or Taso one-on-one.

The full additional fee is due when registering, even if you are paying for your tutoring program in monthly installments.

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Agreement

I understand that I am registering for one-on-one tutoring and/or coaching with Empowered Learning. All tutoring sessions take place online via Zoom, until it is safe to resume in-person tutoring at 2500 Galen Drive, Champaign. Elizabeth and Tasos Sotiropoulos reserve the right to determine when it is safe to resume in-person tutoring. Even after in-person tutoring resumes, students can continue to participate through Zoom.

I understand that committing to tutoring means I am committing to my own success, or to the success of my child.

I agree to pay for the entire semester on time (either in one payment before my or my student's first tutoring session OR in equal monthly payments.) If I am submitting this form after the start of the semester, I will pay a pro-rated sum for the semester. The pro-rated total cannot be less than 50% of the tuition for the program I'm registering for.

I understand that the tutoring time(s) I have selected above aren't guaranteed until Empowered Learning confirms my registration. I understand I will receive this confirmation by email.

I agree to fill out a Reschedule Request form at least 24 hours notice if the student above needs to reschedule their tutoring session. I understand tutoring sessions will not be rescheduled or made up one-on-one if I do not give 24 hours notice; however, missed tutoring sessions can be made up at walk-in hours, which are scheduled at various times and days each month.

I understand that the hours I'm signing up for are for the Fall Semester only, and they are intended to be scheduled on a regular schedule. I understand that any tutoring hours that I choose to reschedule must be scheduled and attended by December 8th, 2020, and if I do not use them, they will expire and they cannot be used in future semesters (unless I have an extenuating circumstance and I get approval from Elizabeth or Tasos Sotiropoulos in writing.)

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You're all done here! Skip over to the next page.

Selecting a Test Prep Package

The package of hours you select must be completed by the student's goal test date.

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SAT Subject Test

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Agreement: Student's Availability

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Student Background

Your responses below will help us match your student with the right tutor. They also help us understand how we can best serve your student. Please write as much or as little as you'd like for each question.

Tell us how what a great tutoring experience will be like. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

What is the student's current attitude toward the subject they'll be receiving tutoring in? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

How much homework do you expect your student's tutor to assign each week? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Over the past 10 years, we have worked with students from a wide variety of backgrounds. Each student is unique, and we value the strengths, intelligences, and interests in every single student. We help our students view their struggles as future super powers.

It helps us to know if the student is going through some challenges or changes in their life. Often times, these challenges and changes impact their grades, test scores, and confidence in school. We don't discuss these challenges or changes during tutoring if it's not relevant to tutoring, but it helps us understand what other factors may be impacting their grades, test scores, and confidence.

If there is anything you think we should know about this student, please share your thoughts here.

What should we know about this student? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Consent and Agreement Page

Consent to Work with a Tutor

Rescheduling Policy

Trimester Commitment

On-Time Payment Policy

Policy Against Unlawful Harassment, Discrimination, and Retaliation

Prohibited Conduct

Sexual or other unlawful harassment or discrimination includes any verbal, physical, or visual conduct based on sex, race, age, national origin, disability or any other legally protected basis if:

submission to such conduct is made either explicitly or implicitly a term or condition of an individual’s employment or engagement with Illini Tutoring LLC;
submission to or rejection of such conduct by an individual is used as a basis for decisions concerning that individual’s employment or engagement with Illini Tutoring LLC; or
it creates a hostile or offensive work environment.

Test Prep Agreement

I give consent for tutoring and I agree to follow the policies above. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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I agree to all terms in the Test Prep Agreement. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Signature of person responsible for tutoring payment {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

I understand the $250 deposit cannot be refunded unless the program I'm registering for is not available. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Paying by check or cash? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Instructions for Paying by Check or Cash

If you wish to pay by check or cash, you will need to mail or bring a check to our office before you can submit this form. (Do NOT mail cash!)

1.) Please SAVE your form and submit your payment.

Enter confirmation code below {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Promotional Code (Optional) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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The email has been sent.

Your progress has been saved.

Copy your form link:

Email me my link:

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Fall Semester 2020: Tutoring Registration Form

This registration form can be used for all one-on-one tutoring programs at Illini Tutoring. We MUST have this form on file for every student.

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{binding Name} - {binding Description}	{binding displayValue}
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{{ Cognito.resources['order-total-label'] }}: {binding displayValue}
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Logo of Empowered Learning, formerly Illini Tutoring

Fill out this form for ONE-ON-ONE tutoring only.

If you are signing up for group tutoring, please fill out the GROUP TUTORING form.

Student's Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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How do you pronounce the student's first name? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Who is responsible for tutoring payments? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Name of person responsible for payment {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Email address for the person listed above {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Parent/guardian's Email (if paying party is not the parent/guardian) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Parent/guardian's Phone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Student's Phone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Student's Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Student's Birthday {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Has the student ever been diagnosed with any of the following? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Student's Mailing Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Emergency Contact Info

Emergency Contact Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Emergency Contact Relationship to Student {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Emergency Contact Phone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Semester Tutoring Plans and Tuition

Fall Semester Rates and Information

Students can register at any time during the school year, even in the middle of a semester. Your total will be pro-rated.

There is an additional charge of $10/Sunday for sessions scheduled on Sundays.

The rates shown below are the TOTAL cost for an ENTIRE SEMESTER.

There is a discount for paying for the entire semester at registration.

Tutoring Subjects

Please choose the subjects the student needs tutoring in below.

Choose Tutoring Subjects

Additional Classes from Same Category {binding ItemNumber}

One-on-One Scheduling: Tutor Preferences and Availability

Math, science & writing (academic) one-on-one tutoring students meet with the same tutor on a regular schedule.

Instructor/Tutor Preferences (optional) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Student Availability

Please check *every single hour* below that the student is available to come to Illini Tutoring.

Not all tutors are available at all the hours listed below. We strongly encourage you to choose all available hours!

Indicate your scheduling preferences in the text box below.

Sundays (additional fee $10/session - we will add this fee to your next invoice) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Mondays {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Tuesdays {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Wednesdays {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Thursdays {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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What days and times do you prefer? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Academic Tutoring (monthly installments)

Elizabeth and Taso are the owners of Empowered Learning. They train and oversee every instructor. There is an additional fee to work with Elizabeth or Taso one-on-one.

The full additional fee is due when registering, even if you are paying for your tutoring program in monthly installments.

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Agreement

I understand that committing to tutoring means I am committing to my own success, or to the success of my child.

I understand that the tutoring time(s) I have selected above aren't guaranteed until Empowered Learning confirms my registration. I understand I will receive this confirmation by email.

Signature of person responsible for tutoring payment {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

You're all done here! Skip over to the next page.

Selecting a Test Prep Package

The package of hours you select must be completed by the student's goal test date.

Do you want to register for additional hours for a different test prep date? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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SAT Subject Test

Additional Tests {binding ItemNumber}

Sunday Availability {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Monday Availability {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Tuesday Availability {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Wednesday Availability {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Thursday Availability {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Preferred Times and Days {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Known Conflicts with times selected above {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Agreement: Student's Availability

I have read the above Availability Agreement Statement, and I agree to all parts of it. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Nothing to see here! Skip over to the next page!

Student Background

Tell us how what a great tutoring experience will be like. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

What is the student's current attitude toward the subject they'll be receiving tutoring in? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

How much homework do you expect your student's tutor to assign each week? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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If there is anything you think we should know about this student, please share your thoughts here.

What should we know about this student? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Consent and Agreement Page

Consent to Work with a Tutor

Rescheduling Policy

Trimester Commitment

On-Time Payment Policy

Policy Against Unlawful Harassment, Discrimination, and Retaliation

Prohibited Conduct

Sexual or other unlawful harassment or discrimination includes any verbal, physical, or visual conduct based on sex, race, age, national origin, disability or any other legally protected basis if:

submission to such conduct is made either explicitly or implicitly a term or condition of an individual’s employment or engagement with Illini Tutoring LLC;
submission to or rejection of such conduct by an individual is used as a basis for decisions concerning that individual’s employment or engagement with Illini Tutoring LLC; or
it creates a hostile or offensive work environment.

Test Prep Agreement

I give consent for tutoring and I agree to follow the policies above. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

I agree to all terms in the Test Prep Agreement. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Signature of person responsible for tutoring payment {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

I understand the $250 deposit cannot be refunded unless the program I'm registering for is not available. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Paying by check or cash? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Instructions for Paying by Check or Cash

If you wish to pay by check or cash, you will need to mail or bring a check to our office before you can submit this form. (Do NOT mail cash!)

1.) Please SAVE your form and submit your payment.

Enter confirmation code below {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Promotional Code (Optional) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Fall Semester 2020: Tutoring Registration Form

Fill out this form for ONE-ON-ONE tutoring only.

If you are signing up for group tutoring, please fill out the GROUP TUTORING form.

Semester Tutoring Plans and Tuition

Fall Semester Rates and Information

Tutoring Subjects

Choose Tutoring Subjects

Additional Classes from Same Category {binding ItemNumber}

One-on-One Scheduling: Tutor Preferences and Availability

Student Availability

Agreement

Selecting a Test Prep Package

SAT Subject Test

Additional Tests {binding ItemNumber}

Student Background

Consent and Agreement Page

Policy Against Unlawful Harassment, Discrimination, and Retaliation

Prohibited Conduct

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Fall Semester 2020: Tutoring Registration Form

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Fill out this form for ONE-ON-ONE tutoring only.

If you are signing up for group tutoring, please fill out the GROUP TUTORING form.

Semester Tutoring Plans and Tuition

Fall Semester Rates and Information

Tutoring Subjects

Choose Tutoring Subjects

Additional Classes from Same Category {binding ItemNumber}

One-on-One Scheduling: Tutor Preferences and Availability

Student Availability

Agreement

Selecting a Test Prep Package

SAT Subject Test

Additional Tests {binding ItemNumber}

Student Background

Consent and Agreement Page

Policy Against Unlawful Harassment, Discrimination, and Retaliation

Prohibited Conduct

Your progress has been saved.

Fall Semester 2020: Tutoring Registration Form

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Fill out this form for ONE-ON-ONE tutoring only.

If you are signing up for group tutoring, please fill out the GROUP TUTORING form.

Semester Tutoring Plans and Tuition

Fall Semester Rates and Information

Tutoring Subjects

Choose Tutoring Subjects

Additional Classes from Same Category {binding ItemNumber}

One-on-One Scheduling: Tutor Preferences and Availability

Student Availability

Agreement

Selecting a Test Prep Package

SAT Subject Test

Additional Tests {binding ItemNumber}

Student Background

Consent and Agreement Page

Policy Against Unlawful Harassment, Discrimination, and Retaliation

Prohibited Conduct