Flexible Pricing RequesT Please complete the form below Name * First Name Last Name Email * A note about this form: When I went into business, I made a commitment to provide people with affordable and pro-bono options despite my financial commitments. Please note, I lost my entire income in 2020 during the pandemic and I am still recovering and in significant debt. I personally and professionally understand the hardship and want to support as many people as possible while meeting my financial obligations. Please do not hesitate to use this form if you cannot afford to pay $125 an hour for 1-on-1 services or the current rate for the admissions support group. However, if you can afford to pay $125 an hour or the current rate for the support group but would rather pay less, we ask that you consider other tutoring services. Please do not use this form to negotiate or seek an unnecessary discount. Every discount has a financial impact on our business and limits our ability to provide discounted and pro-bono services. We trust those who use this form do so with integrity and honesty to ensure we are able to continue and aren’t trying to get one over. Do you understand? * Yes No Our typical flexible pricing range is $75 to $125 an hour for those eligible. We typically work with students 2-3 hours a week initially then 1.5 to 2 hours per week after we have reviewed the foundational lessons. If you are eligible, what price could you afford PER HOUR * $75 per hour $80 per hour $85 per hour $90 per hour $95 per hour $100 per hour $105 per hour $110 per hour $115 per hour $120 per hour $125 per hour Requesting a price below the range (may require additional information) Requesting pro-bono/free assistance (may require additional information) Reason for Applying (Choose as many as applicable) * Currently Qualifies for Unemployment Loss of Income Significant reduction of income Currently Qualifies for Medicaid Currently Qualifies for Free and Reduced Lunch Currently Qualifies for Welfare Caretaker Makes Less than 60k per year combined Parent/Caretaker in Default for Child Support Currently on Disability or out of work due to disability Currently Furloughed or on temporary leave from work Currently in Foster Care Unable to work due to current Visa/Immigration Issues Significant Medical Debt/Medical Hardship Single Parent Household Loss or Reduction in Child Support Reason Not Listed Above or Additional Reasons (please provide information in the additional information section) Financial Strain Due to Student Debt/Debt taken on for student in college COVID Related Hardship Could you provide additional documentation if required * Yes No Additional Information- Pease provide any additional information you would like for us to consider. If there is nothing else please put N/A * By submitting this form you certifying the information provided correct and accurate at this time. If your financial circumstances changes for the better or worse, please contact her manager (contact@jennthetutor.com) to request an adjustment. Is this information true/correct Yes No Thank you!