Payment Form, Atlanta Scholars

Parent-Student Information

Parent's Name*

First Last

Parent's Email*

Student's Name*

First Last

Billing Address*

Street Address Address Line 2 City State ZIP Code

Choose Your Tutoring Package

The cost of your package will be determined by the zip code of the location where we will be tutoring your student. This is not always your home, so please do not put your home address unless you are sure that's where the tutoring will be taking place.

Is the Tutoring Location the Same As Your Billing Address?*

Tutoring Address

Street Address Address Line 2 City State

Full address of tutoring location.

Type of Tutoring Desired

Zip Code of Tutoring Location*

Academic Tutoring Package

Choose a package of tutoring hours

12 Hrs @ $62/hour (Typically 3-4 Weeks)
15 Hrs @ $57/hour - Get 2 hours free (Typically 4-5 Weeks)
18 Hrs @$52.70/hour - Get 3 hours free (Typically 5-6 weeks)

Standardized Test Tutoring Package

Choose a package of tutoring hours

12 Hrs @ $64.16/hour (Typically 3-4 Weeks)
15 Hrs @ $62/hour - Get 0.5 hours free (Typically 4-5 Weeks)
18 Hrs @$55.5/hour - Get 2.5 hours free (Typically 5-6 weeks)

Promotional Code

Total Cost of Tutoring Package

$0.00

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Card Number Expiration Date Security Code Cardholder Name

Atlanta Scholars

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Parent-Student Information

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