Academic Support Form

Academic Support Options

Please select the Tutoring Package you want. Don't worry if you're unsure right now: just pick the one you think is right for your student, and we'll help you confirm or change what you've selected! A $199 Registration Fee will be collected at the end of this form.
Name *

First Name Last Name
E-mail *
Phone Number *
Student's Name *

First Name Last Name
Where does the Student Attend High School? *
Oops! We're sorry. Please tell us where your child attends high school:
What grade is your student in for the 2019-2020 School Year? *

9th Grade 10th Grade 11th Grade 12th Grade

How do you intend to pay for sessions? (Only Registration Fee is Due Today)

In-Full (due after first 3 sessions) Weekly - Payments will be charged weekly at 5:00 pm on Fridays Monthly - Monthly Charges made within 30 days of registration Cash/Check immediately after session is over

Registration Fee

Registration Fee $ 199.00

Total $ 0.00

Tell us about your student! (hobbies, activities, clubs, sports, games, etc).
By filling out this form, I am agreeing to let Modern Muse Education contact me using the e-mail address and/or phone number listed above within 24 hours of the form submission to begin tutoring: *

I agree
Should be Empty:

Academic Support Options