Teacher Referral Form 2024/25 Academic Year

Thank you for taking the time to complete this application and carefully read the updates within it.

We welcome referrals for all our programs! If you are referring a student for our Tutoring Program, please note that we ONLY offer English literacy tutoring.

When referring a student for our tutoring program, please take into consideration that there are many dynamics involved in matching students with a tutor, including our dependency on volunteer availability, thus we cannot guarantee a space for all applicants.

Important information for the 2024/2025 Academic Year:

Tutoring enrollment will take place from August 1st to November 30th. Students can apply at any time. Note, students will not be able to enroll in our one-on-one tutoring after November 30th!
When refering a student to our programs, you must have made contact with the family and/or return this form with a parent application form. We will then reach out to the student's family to discuss the logistics of our tutoring program and work to match the student with a tutor as soon as possible.
All application materials for our current club session and for our tutoring program can be found here.

Teacher Name *

First NameLast Name

Teacher Email*

example@example.com

To nominate a student for TLC, you must have made contact with the family and/or return this form with a parent application form. Does TLC have permission to contact this family?*

YesNo

Student's Name*

First NameLast Name

Student's Grade*

Current F&P Level *

Which TLC program are you nominating this student for?*

TutoringEnrichmentFamily Literacy

Priority (1 being the highest)*

Student's gender

FemaleMale

School*

Parent Contact *

First NameLast Name

Parent Phone Number*

Area CodePhone Number

Parent Email*

example@example.com

Parent's preferred language *

If not English, indicate English proficiency*

NoneLimitedConversational

The child is being referred for assistance primarily for the following reasons, please check all that apply and explain:

Academics

Family

Family SupportFamily ChangesOther

Behavior

Classroom BehaviorBullyingSelf Esteem

Social Skills

Communication skillsPeer RelationsOther

Please explain your above choices

Reason why this student might benefit from tutoring or enrichment: *

What non-academic interests, either in-school or out, does the child have?

Additional comments (if necessary):

TLC Teacher Recommendation Form