Tutor Request Form

Program Overview (K-12 only)

At Lil Readers, we have highly qualified tutors who provide reading, math, and science tutoring to Kindergarten through 12th grade students. Students can engage in two or three 45-minute sessions per week, each tailored to their individual needs. With a teacher-to-student ratio of 1:5 for K-5 and 1:10 for 6th-12th, we ensure a supportive learning environment. Plus, we offer a 10% discount for siblings, making our high-quality education more accessible to families. Please allow our staff 3-5 business days from submission to confirm your schedule. Cost of summer attendance: Two days of tutoring per week= $175 per month, three days of tutoring per week= $225 per month.
Personal & Contact Information

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

First NameLast Name
Grade
Gender
Birth Date

MonthDayYear
What school does your child attend?
Which location are you enrolling in?
Which subject(s) would you like your child to receive tutoring in? Please note that we assess students in math and reading initially. If we find any deficits, we will notify you.
How did you learn about us? (If you were referred by anyone, please list their name)
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
Format: (000) 000-0000.
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.)
Tutoring is more impactful when students are enrolled continuously for at least 3 months. We also offer a 10% discount for parents who register for a semester (4 months total). However, we can be provide tutoring on a month to month basis. Which option do you choose?
Select Start Date
You have the option for your child to receive tutoring 2 or 3 days per week. How many times would you like them to tutor?
Our NLR location is open Monday - Wednesday in the summer. Which days would you prefer?
Select a start time that works best for you. We meet Monday-Wednesday. The times you select are the times you are able to commit to.
What payment option is suitable for you?
Do you have any additional comments/concerns?

My Products

New Student Registration Fee

This non-refundable registration fee guarantees the student spot for tutoring sessions. Fees will be used to purchase student supplies. It is not applied to total costs.

$15.00 Quantity

Returning Student Registration Free

This is ONLY for students who were in our program during 2025. This is a non-refundable registration fee guarantees the student spot for tutoring sessions. Fees will be used to purchase student supplies. It is not applied to total costs.

$5.00 Quantity

Total

Payment Methods

Credit Card

Cash App Pay

Should be Empty:

Program Overview (K-12 only)

Personal & Contact Information

My Products

Payment Methods