Online Tutoring / Music Instruction Request Form

Tutors and/or music instructors should complete and submit a request form for each student that they instruct. Once this online request is submitted:

An email will be sent by the Auxiliary Programs Office to the parent of the student asking for parent approval of the requested instruction session. Parental approval is required before sessions may begin.
The instruction request will be evaluated by the appropriate Learning Specialist or Division Head.
Upon approval by the Learning Specialist or Division Head, an instruction space will be assigned by the Auxiliary Programs Office.
A confirmation email will be sent to the tutor/music instructor indicating the assigned instruction space, eligible start date, and facility use fee.

Invoices for facility use fees will be sent to tutors/music instructors two weeks after the beginning of each quarter. Please refer to the Handbook for Tutors or the Handbook for Music Instructors for information on facility use fees, as well as information on when students may be pulled from classes for tutoring or music instruction.

*Tutor / Instructor Name

*Student Name

*Student Grade

*Parent Name

*Parent Email

*Type of Instruction

*Will the instructor be on-campus for the instruction or connecting virtually?

Is the student currently using a language exemption. (Academic tutoring only)

Yes

No

Is there diagnostic testing on file at Norwood no more than three years old? (Academic Tutoring Only)

Yes

No

Specific Area(s) of intervention/remediation/support

Which instrument (Music Instruction Only)

Other

Requested Day(s) and Time of Instruction

Monday

Monday Start Time

Monday End Time

Tuesday

Tuesday Start Time

Tuesday End Time

Wednesday

Wednesday Start Time

Wednesday End Time

Thursday

Thursday Start Time

Thursday End Time

Friday

Friday Start Time

Friday End Time

*Would instruction occur during a class?

Yes

No

Which Class

Other

*Instructor Electronic Signature