Literacy Grant Tutor Request Form

Program Overview (ADE Literacy Grant Only)

Please note: This application is only for students who have received the ADE Literacy grant. Lil Readers provides small group tutoring to students in Kindergarten through 12th grade. Enrolled students engage in two 45 minute sessions per week with a highly qualified tutor. Students are assessed during the first session and have individual growth plans so that each session will be tailored to their needs. The teacher to student ratio is 1:5 for K-5, 1:10 for 6-12. Please allow our staff 48-72 hours to respond after submitting registration.
Personal & Contact Information

Please make sure all information is accurate.
Student's Name*

First NameLast Name
Grade*
Did you receive the ADE Tutoring Literacy Grant?*
We are only able to provide reading tutoring under this grant
Gender*
What school does your child attend?*
How did you learn about us?*
Birth Date*

MonthDayYear
Does your child have any learning disabilities or any behaviors that we should know about? Providing this information helps with developing a learning plan that's catered to your child. *
If you have a copy of student data, upload here. (acceptable data: NWEA scores, ACT Aspire scores, reading level data, report cards only if it is skilled based with a number rating of 1-4)

Cancelof
Parent's Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*
Will you be signing up any siblings? If yes, please provide name and grade. (You will need to fill out a separate request for each child.) *
Do you have any additional comments/concerns?*
The following days are available for tutoring. Please select the days that work best for your schedule*

Monday and Wednesday
Select a start time that works best for you. The times you select are the times you are able to commit to.*

4:00pm4:15pm4:30pm4:45pm5:00pm5:15pm5:30pm5:45pm6:00pm6:15pm
Should be Empty:

Program Overview (ADE Literacy Grant Only)

Personal & Contact Information