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  • Readers in Training Pre-Qualification Form

    This program is brought to you by Spread the Word Nevada in partnership with United Way of Southern Nevada, Andrews Family Foundation and the Routh Family Foundation.

  • Did you know that reading readiness begins at birth? Spread the Word Nevada's new program, Readers in Training (RIT), is making it possible for your younger children to join in the fun!

  • Thank you for your interest in the Readers in Training program! This form has moved to https://form.jotform.com/stwnprograms/RIT-pre-qualification

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  • Tell Us About Your Children

  • Of those children at home, how many were born AFTER September 1, 2017?*

  • Please list the name and date of birth of children that were born AFTER September 1, 2017.
  • Child 1 Ethnicity*
  • Child 1 Race*
  • Child 1 Date of Birth*
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  • Does Child 1 attend a preschool program?*
  • Child 2 Ethnicity
  • Child 2 Race
  • Child 2 Date of Birth
     - -
  • Does Child 2 attend a preschool program?
  • Child 3 Ethnicity
  • Child 3 Race
  • Child 3 Date of Birth
     - -
  • Does Child 3 attend a preschool program?
  • Child 4 Ethnicity
  • Child 4 Race
  • Child 4 Date of Birth
     - -
  • Does Child 4 attend a preschool program?
  • Child 5 Ethnicity
  • Child 5 Race
  • Child 5 Date of Birth
     - -
  • Does Child 5 attend a preschool program?

  • Contact Information

  • Preferred method of contact (select all that apply)*
  • Will you allow STWN to send you text messages?*

  • Household Information

  • Does anyone in your household qualify for any federal assistance?*
  • Select the Federal Assistance you receive (select all that apply)
  • Do you as the caretaker speak and understand the English language?*

  • Readers In Training Agreement

    We are so excited to go down this journey with you! We are going to have so much fun over the next 4 months. Please review the information below:
    • I agree to engage on the private Facebook page with other families to get the most out of my experience.
    • I agree to participate in the surveys and questionnaires sent out that will assess my learning, my child(ren)'s progress, and the quality of the program.
    • I understand that this program is offered to families who have agreed to participate. As such, I agree to keep all information pertaining to other people in the program confidential. I will not share any photos, posts, or material outside of our private page. It is important for our families to know this is a safe place to share information.
    • I agree to participate in the LIVE virtual training sessions. I will do my best to participate in all 4 sessions and understand if I cannot attend, I will contact the instructor and will watch the recording of the session on my own time.
    • I agree to participate in the 4 face-to-face sessions. I understand this is where I will get to choose books for my child(ren) to keep, interact with families, and learn tips and tools to use at home. I understand that if I miss more than 2 of the face-to-face sessions, I will be removed from the program.
    • I agree to have fun.
  • Do you agree to the above program requirements?*

  • Required Virtual Training Sessions

  • Virtual training sessions are 30 minutes in length and are offered four times per month. Participants are required to attend at least one. All sessions take place during the third week of each month. Please select the time that works best for your schedule*
  • Face to Face training sessions are 45-60 minutes in length and are offered four times per month. Participants are required to attend at least one. All sessions take place during the last week of each month. Please select the session that works best for your schedule. East Las Vegas Library is located at 2851 E Bonanza Rd, Las Vegas, NV and Stupak Community Center is located at 300 W Boston Ave, Las Vegas, NV 89102.*
  • What time frames work best for you (select all that apply)?

  • Connectivity Questions

  • Do you currently have a Facebook account?*
  • What type of device will you be using for virtual training sessions?

  • What type of transportation will you use to get to our face to face trainings?

  • Media/Photo Release

  • I hereby grant Spread the Word Nevada permission to use my name, quotation and/or my likeness in a photograph or video in any and all of its publications, including website entries, without payment or any other consideration.

    I understand and agree that these materials will become the property of Spread the Word Nevada and will not be returned.

    I hereby irrevocably authorize Spread the Word Nevada to edit, alter, copy, exhibit, publish or distribute this photo and/or my quote or video for purposes of publicizing Spread the Word Nevada’s programs or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness or quote appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph, video or quotation.

    I hereby hold harmless and release and forever discharge Spread the Word Nevada from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

    I am at least 18 years of age and am competent to contract in my own name. I have read this release before signing below and I fully understand the contents, meaning, and impact of this release.

  • I agree to have my photo taken and used for Spread the Word Nevada marketing purposes*

  • Who should we contact in the event of an emergency?

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  • Thank you for the information!

    Please hit submit and check your email for confirmation
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