The Word Nerd Intake Form
4. Preferred Contact Method
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4. Preferred Contact Method
5. Are you a student or completing this form on someone's behalf?
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5. Are you a student or completing this form on someone's behalf?
6. What school are you enrolled in?
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7. What year are you in?
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8. What is your program? or what kinds of courses are you taking?
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9. Are you registered with your school's disability/accessibility services?
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9. Are you registered with your school's disability/accessibility services?
10. If yes, please provide contact information (name, phone number, email) for your Accessibility Advisor or point of contact for accommodations.
11. What academic areas are you hoping to get support with? (Check all that apply)
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11. What academic areas are you hoping to get support with? (Check all that apply)
12. How often are you hoping to meet?
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12. How often are you hoping to meet?
13. Preferred session format:
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13. Preferred session format:
14. How do you describe the way your brain works when it comes to learning or focus? (e.g., I get distracted easily, I process things slowly, I have trouble starting)
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15. Anything else you'd like me to know before we meet?
