Student Intake Form to Learning Profile

Turns a filled-in intake form, however messy, into a clear learning profile the tutor can read in a couple of minutes before the first session.

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Before and after

BEFORE · what the owner typed

New student for Oakhurst Learning Center. Mom filled out the form, I typed it below. Tutor will be Joyce Koh, first session Sat Mar 8. Student: Jorge Horvat, 7th grade, Lynnhurst Middle. Parent: Jolene Giordano, 267-555-0176, jolene's email on file. Lives 3607 Lindenhurst St, Otterfield. Wants help w/ math, pre-algebra mostly, and writing. 'He freaks out on word problems and just stops.' Writing: 'ideas are great but paragraphs are all over the place.' Loves drawing, builds mechanical stuff, has a pet bearded dragon named Gizmondo. Gets bored fast if it's worksheets. Does better when he can see it drawn out, mom says. Mom mentioned he has a 504 plan for attention, she said 'extended time on tests.' Goal: be ready for the pre-algebra final in June and feel less scared of math. Can do Tuesdays and Thursdays after 4:30, Saturdays mornings. Mom drops off, drives a 2012 Volkswagen Tiguan, red. Backup contact is dad, Joseph Jennings, 267-555-0177. No info on reading level, no info on what the teacher says.

AFTER · what the skill produced

Learning Profile: Jorge Horvat
Prepared for Joyce Koh, Oakhurst Learning Center

Student basics
Jorge Horvat, 7th grade, Lynnhurst Middle.

Why they are here
Jorge's mom, Jolene Giordano, wants help with math (mostly pre-algebra) and writing.

Subjects and current level

Math: pre-algebra. Level or recent grades not provided.
Writing: level or recent grades not provided.
Reading: not provided.

Strengths and interests

Loves drawing and builds mechanical things.
Has a pet bearded dragon named Gizmondo.
Writing: "ideas are great."

Challenges the family described

Math word problems: "He freaks out on word problems and just stops."
Writing: "paragraphs are all over the place."
Gets bored fast with worksheets.

How the student learns best (as the family described it)

Does better when he can see a problem drawn out.

Shared by the family

Jorge has a 504 plan for attention, with extended time on tests. Family-reported, not assessed by us.

Goals and deadlines

Be ready for the pre-algebra final in June.
Feel less scared of math.

Schedule and logistics

Available Tuesdays and Thursdays after 4:30, and Saturday mornings.
First session: Saturday, March 8.
Mom drops him off in a red 2012 Volkswagen Tiguan.
Home address: 3607 Lindenhurst St, Otterfield.

Contacts

Jolene Giordano (mom): 267-555-0176
Joseph Jennings (dad, backup): 267-555-0177

First session focus

Start with a word problem and have Jorge draw it out, since mom says he does better seeing it drawn (ties to word-problem stops).
Try a short paragraph-planning exercise, using something he likes such as drawing or building (ties to scattered paragraphs).
Keep the work hands-on instead of worksheets (ties to getting bored fast).

Questions for the owner

What is Jorge's current math grade, and what does his teacher say about where he struggles?
What is his reading level, if the family knows it?
Does the family want us to see the 504 plan, or is the extended time on tests all we need to know?
What is the exact date of the June pre-algebra final?
Should Jorge's mom be told which of Tuesday, Thursday, or Saturday we recommend for the regular slot?

What it does

Turns a filled-in intake form, however messy, into a clear learning profile the tutor can read in a couple of minutes before the first session. Keeps the family's own words and flags anything missing.

Use it when: Use when a tutoring business needs to turn a parent's or student's intake form, plus any notes from a first call, into a one-page learning profile for the tutor, such as "make a learning profile from this intake form" or "summarize this new student for the tutor."