Student Registration Student Registration 1 Student Information2 Parent Information3 Weekly Availability 4 Educational Information5 Billing Information Student InformationStudent Name* First Last Date of birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Email* Primary Contact Number*Secondary Contact NumberMailing AddressAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Parent InformationMother's Name First Last Home NumberMobile NumberEmail Father's Name First Last Home NumberMobile NumberEmail Weekly AvailabilityMark slots available for tutoringMonday 8:00AM - 10:00AM 10:00AM - NOON 12:00PM - 2:00PM 2:00PM - 4:00PM 4:00PM - 6:00PM 6:00PM - 8:00PM 8:00PM - 10:00PM Tuesday 8:00AM - 10:00AM 10:00AM - NOON 12:00PM - 2:00PM 2:00PM - 4:00PM 4:00PM - 6:00PM 6:00PM - 8:00PM 8:00PM - 10:00PM Wednesday 8:00AM - 10:00AM 10:00AM - NOON 12:00PM - 2:00PM 2:00PM - 4:00PM 4:00PM - 6:00PM 6:00PM - 8:00PM 8:00PM - 10:00PM Thursday 8:00AM - 10:00AM 10:00AM - NOON 12:00PM - 2:00PM 2:00PM - 4:00PM 4:00PM - 6:00PM 6:00PM - 8:00PM 8:00PM - 10:00PM Friday 8:00AM - 10:00AM 10:00AM - NOON 12:00PM - 2:00PM 2:00PM - 4:00PM 4:00PM - 6:00PM 6:00PM - 8:00PM 8:00PM - 10:00PM Saturday 8:00AM - 10:00AM 10:00AM - NOON 12:00PM - 2:00PM 2:00PM - 4:00PM 4:00PM - 6:00PM 6:00PM - 8:00PM 8:00PM - 10:00PM Sunday 8:00AM - 10:00AM 10:00AM - NOON 12:00PM - 2:00PM 2:00PM - 4:00PM 4:00PM - 6:00PM 6:00PM - 8:00PM 8:00PM - 10:00PM Educational InformationEducational InstitutionGrade/Year/LevelCourse TypeSemesteredNon SemesteredOtherBRIEFLY DESCRIBE STUDENT'S CHALLENGESPlease include grade expectations/personal goals/career aspirations, and any other relevant information.WHAT DO YOU HOPE TO GAIN FROM ADDED SUPPORT?Please include grade expectations/personal goals/career aspirations, and any other relevant information.SUPPLEMENTARY DOCUMENTS PREVIOUS REPORT CARDS GRADE POINT AVERAGE AND GRADE HISTORY STANDARDIZED TESTING SCORES (EQAO, OSSLT, SSAT, SAT, ACT, GMAT, TOEFL, IELST) SAMPLES OF WORK INDEPENDENT EDUCATIONAL PLAN (IEP) PSYCHO-ED ASSESSMENT RESULTS STUDENT’S PERSONAL ESSAY RCM CERTIFICATION DOCUMENTS AWARDS/ACHIEVEMENTS PARENT’S ESSAY LETTER FROM PREVIOUS INSTRUCTOR File Attachment (PDF Format Only)* PDF Format Only * Use this Free Online PDF Converter CLICK HERE TO CONVERT YOUR FILES TO PDF Billing InformationName First Last Phone NumberEmail Billing Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country ACADEMIC PACKAGEAD HOC ($60/Per Hour) $60.0010 - HOUR PACKAGE (550.00)15 - HOUR PACKAGE ($825.00)20 - HOUR PACKAGE ($1100.00)50 - HOUR PACKAGE ($2750.00)110 - HOUR PACKAGE ($6000.00)Test Only - Admin's OnlyPREFERRED PAYMENT METHODPAYPAL OR CREDIT CARDINTERACT E-TRANSFERCHEQUETotal $ 0.00 CAD If you pay by chequePlease address to Arcanum Educational Services Inc, place in the memo line, and mail to 220 Tom Taylor Cres. Newmarket, ON, L3X 3E8. If you opt for an E-transferPlease indicate Arcanum Academy as the recipient and use the email address: inquire@arcanumtutoring.com.EmailThis field is for validation purposes and should be left unchanged.
