Reading is Magic Summer Camp Teacher Referral Form 2023

Today's Date

Student First & Last Name*

Student ID number

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 Mailing Address:*

Parent/Guardian City and Zip Code:*

Parent Email:

Parent/Guardian Cell Phone Numbers*

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?

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?

Is this student part of the SFPS Native American Student Services Program?*

What accommodations and extra support does this child receive at school?

Has this student been previously retained? If so, in which grade?

Will the student 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

Reading is Magic Camp Teacher Referral Form 2023