Cambridge Learning Center of New Jersey Confidential New Parent/Student Interest Form

Personal Information

Student's Full Name *

Student's Gender *

Parent or Parents' Names *

How did you hear about us? Please let us know. Did someone refer you? Internet? Radio? *

Parent's E-mail address (Best one to contact you at) *

Student's E-mail address - (If you don't have it, just write that you will give it to us later) *

For parents of SAT/ACT Students: What is the student's e-mail address? This will be for study tips and for access to online materials. This can be given later if you do not have it right now.

School your child will be in or is in for 2023-2024 School Year. . *

Best phone number to reach you at. *

Is the phone number above a home or mobile number? *

Home Street Address *

City or Town? *

State *

Zip Code *

Student's Date of Birth xx/xx/xxxx *

Current Grade Level In School - (2023-2024 School Year)- If you are filling this out in the summer, this will be the grade they will enter this September 2023. *

Which of our programs are you interested in for your child? *

What is your main reason for coming to see us? *

What is your main end result you would like to see for your child coming to our learning center? *

If your child has taken one or more official SAT or ACT tests, please list the approximate dates and score details below. This is very important for Mr. Buffer and his Ed. Team. If this does not apply to you, you can leave it blank.

We offer a fantastic long-term and short-term College Planning/Essay/Coaching Program in which we help families with all aspects of the college process. Are you interested in learning more about this as space is limited? *

Yes, I would like to learn more.

No, not at this time.

Besides our signature SAT/ACT, Reading, Math, and Writing, programs, we also offer fantastic subject tutoring for many subjects as well as personal growth and coaching. Does your child need help with any of these subjects in school, or in any other of the named areas? *

Has your child been diagnosed with a learning disability or have an IEP? *

If there is anything relevant you would like to upload such as PSAT scores, SAT scores, ACT score, etc. for Mr. Buffer, our Educational Director and Head Teacher, to see you can do so here. All information is confidential and goes directly to Mr. Buffer prior to your meeting so he can look it over.

If you feel comfortable, please upload an unofficial or official transcript high school transcript. This will help Mr. Buffer get a complete picture of your child and their college prospects. If you cannot upload it, please bring a copy with you. For K-8 students, you can also upload grades here, or bring them with you

Is there anything else you would like for us to know?

Thank you! We look forward to meeting you!