Parent/Student Interest Form – njcambridgelearningcenter.com

Student Full Name

Student's Gender

Parent or Parents' Names

How did you hear about us? Please let us know. Did someone refer you? Internet? Radio?

Parent's E-mail address (Best one to contact you at)

Student's E-mail address - (If you don't have it, just write that you will give it to us later)

For parents of SAT/ACT Students: What is the student's e-mail address? This will be for study tips and for access to online materials. This can be given later if you do not have it right now.

Grade Level for the 2025-2026 School Year - If you are filling this out in the summer, this will be the grade they will enter this September 2025

School Your Child Is In Or Will Be In For the 2025-2026 School Year

Best phone number to reach you at

Is the previous phone number a home or mobile number?

Home Street Address

City or Town?

State

Zip Code

Student's Date of Birth (xx/xx/xxxx)

Which of our programs are you interested in for your child?

What is your main reason for coming to see us?

What is your main end result you would like to see for your child coming to our learning center?

If your child has taken one or more official SAT or ACT tests, please list the approximate dates and score details below. This is very important for Mr. Buffer and his Ed. Team. If this does not apply to you, you can leave it blank.

If your child is in high school do you know what area of study in college they are leaning towards? If this does not apply, or you don't know, you can leave this blank.

If applicable, has your child ever been identified as being on the autism spectrum (ASD)? If so, please feel free to share any details you’re comfortable providing. This information will be kept strictly confidential and is only for Mr. Buffer, Head Teacher, to better understand how to best support your child. if not applicable, please write "NA."

We offer a fantastic long-term and short-term College Planning/Essay/Coaching Program in which Mr. Buffer helps students with all aspects of the college process. Are you interested in learning more about this as space is limited? You can also watch Mr. Buffer's Weekly YouTube show at www.collegeplanningcom - this will take you directly to our YouTube show

Yes, I would like to learn more.

Has your child been diagnosed with a learning disability or have an IEP?

Has your child been granted extra time for standardized testing ?

If there is anything relevant you would like to upload such as PSAT scores, SAT scores, ACT score, etc. for Mr. Buffer, our Educational Director and Head Teacher, to see you can do so here. All information is confidential and goes directly to Mr. Buffer prior to your meeting so he can look it over.

If you feel comfortable, please upload an unofficial or official transcript high school transcript. This will help Mr. Buffer get a complete picture of your child and their college prospects. If you cannot upload it, please bring a copy with you. For K-8 students, you can also upload grades here, or bring them with you

Is there anything else you would like for us to know?

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Yes, I agree

Cambridge Learning Center of New Jersey Confidential New Parent/Student Interest Form

Personal Information