School: ______________________ Other: _________________________ Grade level(s) observed (check all that apply): K 1 2 3 4 5 6 7 8 9 10 11 12 Subject: Student Grouping: Type of Group Number of students in group Language Arts Individual _____________ Mathematics Small _____________ Science Large _____________ For all SES Sessions: Yes No N/A Appropriate tutor : student ratio is maintained as indicated in the provider’s state? approved application (not to exceed 1:5 for small group and 1:10 for large ...
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