We are now enrolling students for the 2018-19 School Year! 

You may either apply online by using the form below or download an application to print and mail in to Lolly's Place.

2018-19 Tutoring Enrollment Form

*Starred information will be used for grant purposes and kept confidential.

If you are interested in scholarships or need-based reduced tutoring rates, please fill out the scholarship information towards the end of the application.

PREFERRED TUTORING DAY (check one)
ABOUT YOUR CHILD
Child's Name
Child's Name
Birthday *
Birthday *
Do you have another child that you would like to enroll?
Teacher’s Number
Teacher’s Number
TUTORING PREFERENCES (Please check all that apply.)
PARENT/GUARDIAN INFORMATION
Parent/Guardian Name
Parent/Guardian Name
Street
City
Zip Code
Home Phone
Home Phone
Cell Phone
Cell Phone
Work Phone
Work Phone
It is best to reach me at:
EMERGENCY CONTACTS (please provide two)
Contact 1 Name
Contact 1 Name
Phone 1
Phone 1
Phone 2
Phone 2
Contact 2 Name
Contact 2 Name
Phone 1
Phone 1
Phone 2
Phone 2
TUTORING PAYMENT POLICY
Tutoring payments are due the fifteenth of the month. The cost is $200 per month, with the exception of September, which is $100.

For eligible families, there are scholarship options available. If you would like more information about scholarship availability, fill out the information below. Upon review of your application, we will contact you to discuss your eligibility. Please note that scholarship funds are limited and distributed at the discretion of the Executive Director.
Total annual household income *
Does your family receive government assistance (Ex. Medicaid, SNAP, etc.)? *

Once this form is completed please pay the $25 registration/supply fee by using the link below or by mailing a check to:

Lolly’s Place
c/o Trinity Presbyterian Church     
6800 Washington Ave.
University City, MO  63130