Reading Quest Teacher Referral Form 2025- 2026

Teacher Referral Form 2025-2026

PLEASE NOTE: The boxes with red stars indicate required fields. Those are the ONLY fields that have to be completed for an initial referral.
Today's Date
Student First & Last Name*
Student School ID#
Teacher Name*
Teacher Email*
example@example.com
Teacher Name & Cell Phone
School*
What grade is this student currently in?*
Does this student receive or is eligible for free or reduced lunch at school?
Parent/Guardian Name(s)*
Parent/Guardian Cell Phone Numbers
Parent/Guardian Email Address
What is the child's primary language at home?
What language(s) is the child learning to read at school?
How much of their day is spent learning in English?
How much of their day is spent learning in Spanish/Keres/other languages?
If you know, what is the ethnicity of this student? Type a label
Why are you referring this student to Reading Quest?*
Does this child have an IEP?
Is an SAT in process?
Please describe this child's behavior in class. What are some areas of strength and areas they are in need of more support?
What accommodations and extra support does this child receive at school?
Has this student been previously retained? If so, in which grade?
Is there a chance that this student might be retained this year?
If yes, why?
Please share any additional information you feel would be helpful for us to know
Reading Quest Director, Rayna Dineen Ph: 505-920-9709

readingquestcenter@gmail.com www.readingquestcenter.org
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Teacher Referral Form 2025-2026