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Academic Support Intake Form

SECTION 1: PERSONAL INFORMATION

Name*

Email*

Phone Number*

Year / Grade Level

Year / Grade Level*

High School Senior

Freshman

Sophomore

Junior

Senior

Graduate Student

SECTION 2: TYPE OF SUPPORT NEEDED

What do you need help with?

What do you need help with?*

Paper / Essay Help (writing, structure, thesis, argument)

Exam / Test Prep (study strategies, content review)

Both Paper and Exam Prep

SECTION 3: ASSIGNMENT DETAILS

Subject / Course Name:*

Assignment Title or Topic:*

Describe what you need help with:*

Deadline / Exam Date:*

How urgent is your request?

Multi choice*

I need help today / tonight

Within the next 2–3 days

I have more than a week

SECTION 4: SESSION PREFERENCE

Preferred Session Length

Multi choice*

30 Minutes

1 Hour

Not Sure — Let Verity Academic Recommend

Preferred Day(s)

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Preferred Time(s)

Dropdown*

SECTION 5: ANYTHING ELSE?

Is there anything else we should know before your session?

Long answer*

By submitting this form, you agree to Verity Academic's cancellation policy (24 hours notice required for cancellations and rescheduling).

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