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Student First Name *Student Last Name *Student Email Address *Parent Full Name *Parent Email Address *Parent Phone Please indicate your role *Student Year Level *Student High School/Intermediate *Subjects (and levels) * Try a max of 2 subjects in the beginningFrequency of Lessons *Lesson Duration (Per Subject)*1 hour is recommended when startingWhat days and times are most convenient for lessons? *Does the student have any diagnosed learning differences or conditions that we should be aware of?Where did you hear about us?Any additional notes?

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Student Application