Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

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Child's Age *

0-3

5-8

9-12

13-16

17-20

Im interested in *

(choose all that apply)

Early Literacy & Pre K Prep

Homeschool PreK-3rd

Homeschool 4th-8th

Homeschool 9th-12th

Special Needs

ESL Instruction/Tutoring

Custom Curriculum Plan

Zoom/Virtual Teacher

Local Pandemic Pods

Microschools+ Co Ops

IEP or IHIP Assistance

Early Diagnosis

Early Intervention

Vaccination Schedule

Bullying

Unschooling

1 on 1 services

Roadschooling

STEMup Field Trips

Education/College Applications

Education/College Funding

Food Stamps

Childcare

Name *

First Name

Last Name

Preferred Date of Consultation *

Please book at least one week in advance of date you would like to meet.

MM

DD

YYYY

Preferred Time of Consultation *

Please consider time zone when booking. I am in PST at the moment.

Hour

Minute

Second

AM PM