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Our Agents
- Meet the Agents
- Apply to be an Agent
About Us
Stories
Students
Contact

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Sign up for an Agent

Sign Up for 24/7 Support with Student Success Agency!

Ready for round-the-clock support? Whether it’s academic help, social guidance, or navigating post-secondary opportunities, our near-peer Agents got your back. This application is intended for families and teens to complete together to ensure a shared commitment to success.

Student's Name(Required)

First Last

Student’s age(Required)

We work with students ages 13-20

School Name and Location

Email(Required)

Enter Email Confirm Email

Phone(Required)

How often do you (teen) plan to use Student Success Agency's wellness services?(Required)

We offer wellness sessions for stress relief, happiness, and mindfulness.

Rarely or never

As needed when stumped

Ongoing 1-2x per month

Ongoing 1x per week

Ongoing multiple times per week

How often do you (teen) plan to use Student Success Agency's tutoring services?(Required)

We offer wellness sessions for stress relief, happiness, and mindfulness.

Rarely or never

As needed if a stressful situation arises

Monthly

Weekly

Multiple times per week

What do you (teen or parent/guardian) need most to help you achieve your (teen’s) goals?(Required)

What is your motivation for applying to join Student Success Agency?(Required)

What outcomes would you need to achieve in 6 months to consider your experience with Student Success Agency a success?(Required)

How did you hear about Student Success Agency?(Required)

Legal Guardian Contact Information(Required)

First Name Last Name

Legal Guardian Email(Required)

Enter Email Confirm Email

Legal Guardian Phone(Required)

Teen’s home address (so we can send you cool swag)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Do you (teen or parent/guardian) have any additional questions you'd like answered?

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