The critical information you share below will be treated sensitively and used to resolve our client’s concern(s) together. Thank you for your concern, character and compassion.

Date of Client Incident/Interaction

YYYY

Client Name

First Name

Last Name

Client Email Address

Instructor Name

First Name

Last Name

Instructor Email Address

Please relay our Client’s Concern(s)

Candor and full disclosure is important and appreciated

Important: what insight can you share that might have elicited this concern/sentiment from our client?

Please describe our Client’s Sentiment/Behavior

Candor and full disclosure is important and appreciated

Please provide a suggested Response to our Client and share your potential Solution(s) for Client/Student

Include your confidence that we can resolve/remediate this issue for the client/student

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Name

First Name

Last Name

Email Address

Service(s) Requested

Standardized Test Prep

Subject Tutoring

Other

Additional Insight

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