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
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First Name
Last Name
E-mail
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Phone Number
*
Format: (000) 000-0000.
Student's Name
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First Name
Last Name
Where does the Student Attend High School?
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Bethesda-Chevy Chase High School
Montgomery Blair High School
James Hubert Blake High School
Winston Churchill High School
Clarksburg High School
Damascus High School
Thomas Edison High School of Technology
Albert Einstein High School
Gaithersburg High School
Walter Johnson High School
John F. Kennedy High School
Col. Zadok Magruder High School
Richard Montgomery High School
Northwest High School
Northwood High School
Paint Branch High School
Poolesville High School
Quince Orchard High School
Rockville High School
Seneca Valley High School
Sherwood High School
Springbrook High School
Watkins Mill High School
Wheaton High School
Walt Whitman High School
Thomas S. Wootton High School
OTHER
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?
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9th Grade
10th Grade
11th Grade
12th Grade
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What Support should we be offering the student?
Math Support (Geometry, Algebra, Pre Calculus, Calculus)
Social Studies Support
Science Support (Physics, Chemistry, Biology)
English Support (includes all English 9,10,11,12 Classes as well as AP Language and AP Literature)]
Foreign Language Support (Spanish I - IV)
Please Select your Office
Gaithersburg Office (18235-A Flower Hill Way, Gaithersburg, MD 20879)
Potomac Office (1201 Seven Locks Road #360, Rockville, MD 20850)
Which Tutoring Package are you interested in?
A-la-Carte ($69/hr)
20 Hours Academic Support - $1,299
30 Hours - $1,599
When is your student available for tutoring? Please select at least three options for best scheduling placement:
Monday: 10:00 am - 3:00 pm
Monday: 3:30 pm - 9:00 pm
Tuesday: 10:00 am - 3:00 pm
Tuesday: 3:30 pm - 9:00 pm
Wednesday: 10:00 am - 3:00 pm
Wednesday: 3:30 pm - 9:00 pm
Thursday: 10:00 am - 3:00 pm
Thursday: 3:30 pm - 9:00 pm
Saturday: 10:00 am - 3:00 pm
Saturday: 3:30 pm - 6:00 pm
Sunday: 10:00 am - 3:00 pm
Sunday: 3:30 pm - 6:00 pm
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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
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Registration Fee
$199.00
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199.00
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Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
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:
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