Continuation Form

Parent Name:*
Preferred Email:*
Preferred Phone Number:*
Student Name:*
Grade:*
School:*
First Day of School:*
We would like to resume services on (start date):*
- We would like to continue with our current Academic Manager (if available).
- We would like to request a new Academic Manager.
Comments or special requests:
Elementary School Students
Area(s) of specific need:
Middle/High School/College Students Schedule
English Subject
Math Subject
History Subject
Science Subject
Foreign Language Subject
Other Subject
I would like my child to receive Academic Management at:
- Home
- Franklin Learning Center
- Other
Other (Please specify):
I would like my child to receive individualized Test Prep during his/her sessions:
- ISEE
- SSAT
- SAT
- Single-Subject SAT
- ACT
Preferred Times
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
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Name
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Brentwood Learning Center
11777 San Vicente Blvd., Suite 129, Los Angeles, CA 90049
(310) 571-1176

Elementary School Students