Application for Local In-Person Tutoring Services or Private Lessons 

  Cole Institute of Language * PO Box 1613 * Flowery Branch, Georgia 30542 * (678) 971-8089 *shannoncole@coleinstitute.com

This form will be sent automatically for review.   This is an application and not a contract of service. Upon approval of this application you will receive a contract for review by email which you may either accept or reject.  If you prefer to fill out a paper application, you may download it from our website. This service is available only in a limited geographic area in Northeast Georgia, USA.  If you live outside this area, please try our private online lessons.

Tutoring session rates are explained at http://www.coleinstitute.com/nega.html and do not include a daily $0.40 per travel mile to your location.  Travel expense waived if held at Spout Springs Branch Library.

If you are a business, church, or social group requesting specialized language lessons or courses in ESL methodology, our rates are explained in the fee chart on the same page as mentioned above.  Please use our business and group application.

SECTION A: General information about the kind of session you are requesting.

Instructions: Please complete this entire section.  If you are a business, church, or social group requesting specialized language lessons or courses in ESL methodology, please use our business/group class application form instead.


How many students will be in the session?
How many days a week do you want to meet?
Which days of the week do you prefer (eg: Mondays and Tuesdays, Fridays, etc.)?
At what time of the day do you prefer (eg: after 2 pm, at 7:30 pm, etc)?
How many total sessions do you want to meet (one time, 5 sessions, 12 sessions, etc.)?
How long do you want to meet in each session?

At what location do you wish to hold the sessions?

Tutoring in one's private home is at the discretion of the tutor.  Public locations, such as libraries, are acceptable (please include the street address, if known.)

Is this for:
Describe the specific service needed (example: Spanish lessons, reading, etc):

SECTION B: Student information.   

Instructions: You can request up to three students from the same household to attend a session together.  If you are only contracting one student, only fill out number 1 and 2.  For two or more students, please fill out numbers 3 through 6.  If you are requesting services for 4 -5 students, provide additional details in Section D.

If you are a parent or guardian contracting services for a minor, please complete all information in this section. 

If you are an adult requesting services for yourself, please fill out all sections EXCEPT those highlighted in orange.

1. Name of Student:
2. Birthday (mm/dd/yy)
3. Student 2 Name
4. Student 2 Birthday (mm/dd/yy)
5. Student 3 Name
6. Student 3 Birthday (mm/dd/yy)
For parents/guardians of minors only Name of Parent Guardian (if student is a minor)

7.

This section is for both parents/guardians or adult students

 Place of employment
8. Work number
9. Home phone number
10. Cell phone number
11. Street and Mailing Address
12. Email address
13. Emergency Contact name
14. Emergency Contact Home phone
15. Emergency Contact Cell phone

For parents/guardians of minors only

 Indicate ALL people who are authorized to pick up your child

For parents/guardians of minors only

 If you give your teenage child permission to drive to or from the session please write his or her name above as an authorized person and initial here

SECTION C: Payment information.

Instructions: This is only for our information purposes in order to complete the contract.  You will not be billed unless you accept the final contract.

Payments must be made in advance.  Please choose your method of payment: Online by credit card or debit card via Paypal
With a check or money order made out to Cole Institute of Language
By Western Union or Moneygram
In cash (terms to be discussed at first meeting)
Name of person responsible for the payment of fees.

SECTION D:  Final comments.

Instructions: Please include any final comments or concerns here.  If you are a business, church, home school group, or social group requesting lessons, please list the number of participants here, including the main contact person, his/her phone number and email address.  Please realize that only one person will be responsible for collecting money and turning in one payment for the whole group.

Other comments or concerns