Reading Quest Teacher Referral Form 2024- 2025

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?

Which language(s) do the parents speak?

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?

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?

Which days and times could this student be seen for 1 hour of tutoring a week during the school day? *

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

Teacher Referral Form 2024-2025