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Mill Creek Mathnasium
1
Are we right for your child?
My child struggles with math
My child excels in math
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2
What grade is your child in?
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Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
Algebra
Algebra II
Geometry
Pre-Calculus
Other
AP Calculus
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3
You marked "other". Tell us what grade/level of math your child is in, please.
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4
How does your child feel about math?
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Check all that apply
Patiently struggling
Won't try
Frustrated
Insecure
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5
Is math homework a source of stress in your home?
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YES
NO
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6
How long has your child struggled with math?
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Weeks
Months
Years
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7
What math concepts is your child struggling with?
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Select all that apply
Addition & subtraction facts
Multiplication & division facts
Fractions
Money/time
Word problems
Decimals/percents
Equations
Geometry
Test-taking
Other
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8
Okay, what other math concepts is your child struggling with?
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9
What is your/your child's goal?
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Select all that apply
To be challenged in math (not getting challenged at school)
Get into advanced program
Skip a grade
Test prep SAT/ACT, SSAT/ISEE or other
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10
Parent/Guardian Name
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First Name
Last Name
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11
Phone Number
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(We'd like to follow up about your student)
Area Code
Phone Number
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12
Email
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example@example.com
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