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Enrollment Questionnaire Form

For the Grand Rapids North Location ONLY.

Student Information & Goals Form

Parent Name *

Parent Email: *

How did you hear about Kumon?

Friend/Family

Online Search

Social Media

School Referral

What are your primary goals or expectations for your child in Kumon? *

How is your child currently performing in school? *

Above Grade Level

At Grade Level

Below Grade Level

What is the main reason you are enrolling your child in Kumon? *

Are there specific subjects or skills your child struggles with? *

Math

Reading

Writing

When did these challenges begin? *

What is your child’s favorite subject? *

What are your child’s current hopes, dreams, or interests for the future? *

Do you feel your child is confident in their academic abilities? *

Yes

Sometimes

Please explain

How much time does your child typically spend on school homework each day? *

Less than 30 minutes

30 minutes to 1 hour

More than 1 hour

Once a week

No homework

Does your child ask for help with homework at home? *

Often

Occasionally

Rarely

Never

What do you do at home to motivate your child academically? *

What kinds of accomplishments make your child feel proud or successful? *

Is there anything else you’d like us to know about your child? *

How flexible is your child’s schedule for attending Kumon sessions regularly? *

Very Flexible

Somewhat Flexible

Not Flexible

Are there any scheduling conflicts or time constraints we should be aware of? *

How long are you planning to commit to the Kumon program? *

Less than 3 months
3–6 months
6–12 months
More than 1 year
Not sure yet
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Are you willing to assist with daily Kumon work or grading at home if needed? *

Yes
No
Maybe
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enrollment questionnaire