Enrollment Form for Prospective Families or Self-Paying Adult Students
Thank you for contacting Brainiac In-Home Tutoring! We are requesting additional information from you to complete the enrollment process. By completing the enrollment form, you are under no obligation to hire us. The purpose of the form is solely for gathering information, as well as assessing how we may help your child or children now or in the near future.
There are no enrollment fees.
Also, you don't have to provide your credit card information during the enrollment process. Once we are in receipt of the enrollment form, we will contact you for scheduling or confirming the first tutorial session.
Please note: Based on tutor availability, traveling to homes will be in selected areas in Michigan and Indiana.
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United States
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Afghanistan
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Bolivia, Plurinational State of
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Bosnia and Herzegovina
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Burkina Faso
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Canada
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Central African Republic
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Chile
China
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Congo, the Democratic Republic of the
Cook Islands
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Côte d'Ivoire
Croatia
Cuba
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Cyprus
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Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic of
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
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Jordan
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Korea, Republic of
Kuwait
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Mali
Malta
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Martinique
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Mauritius
Mayotte
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Moldova, Republic of
Monaco
Mongolia
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Montserrat
Morocco
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Myanmar
Namibia
Nauru
Nepal
Netherlands
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Nicaragua
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Nigeria
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Northern Mariana Islands
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Palau
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Panama
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Paraguay
Peru
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Pitcairn
Poland
Portugal
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Qatar
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Russian Federation
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Saint Kitts and Nevis
Saint Lucia
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Samoa
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Serbia
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Thailand
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Turks and Caicos Islands
Tuvalu
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Ukraine
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United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
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Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
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Zambia
Zimbabwe
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I/We agree to receive informational and service-related text messages from Brainiac In-Home Tutoring at the mobile number provided regarding enrollment, scheduling, tutoring sessions, invoices, payments, and service updates. Message frequency varies. Message and data rates may apply. Reply "STOP" to opt out or "HELP" for assistance. Consent is not required to submit this form, enroll in services, or purchase tutoring services.
Notes
Student/Tutee
First Name
Last Name
Grade
School Name
Challenge Subjects
Accounting 1
Accounting 2
ACT Prep
Admin Support/Support Staff
Algebra l
Algebra ll
Algebra lll
All Core Subjects
Anatomy
Anthropology
AP Algebra
AP Art History
AP Biology
AP Botany
AP Calculus
AP Chemistry
AP English Composition
AP French
AP History
AP Language Arts
AP Literature
AP Physics
AP Pre-Algebra 1
AP Pre-Algebra 1 & 2
AP Pre-Algebra 2
AP Science Courses
AP Spanish
AP Statistics (HS)
AP U.S. History
AP Writing
Archaeology/Anthropology
Art History
Basic Chemistry
Basic Math
Biochemistry
Biology
Calculus
Chemistry
Chemistry ll
Chess
Civics
College Algebra
College Biology
College Chemistry
College Essay Writing
Communication Skills
Computer Science
Computer Skills
Consumer Math
Creative Writing
Drama
Earth Science
Economics
Editing
English
English Composition
Environmental Science
ESL
European History
Foreign Language
French
GED Prep
General Science
Geometry
Government
Graduate STEM Courses
Grammar
Graphing Calculator
Handwriting
Hardware
High School Essay Writing
History
Home-Schooling Academic Support
Homework Assistance
Honors Algebra
Honors Biology
HS Calculus
HS Statistics
HS Trigonometry
Humanities
Japanese
Kindergarten Readiness
Latin
Life Science
Listening
Literature
Macroeconomics
Mandarin (Chinese)
Math
Math: Money
Micro Biology
Microeconomics
Note Taking
Online Tutoring
Organic Chemistry
Organizational Skills
Personal Leave
Phonics
Physics
Physiology
Poetry
PRAXIS Core Math Test Prep
Pre-Algebra
Pre-Calculus
Pre-K Core Subjects
PSAT Prep
Psychology
Punctuation
Punjabi
Reading
Reading Comprehension
Recruiting Support
Religion
Russian
SAT Prep
Science
Sign Language
Skill Building
Small Group Session
Social Media Support
Social Studies
Sociology
Software
Spanish
Spanish (Conversational)
Spanish (Elementary)
Spelling
Standardized Test Prep
Statistics
Study Skills
Test Prep (Basic)
Urdu/Hindi
Vocabulary
Voice
Web and Application Development
Writing
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