LBN Buddy Referral Form (Summer 2025, Fall 2025, Winter/Spring 2026)

LBN Buddy Referral Form

Summer 2025, Fall 2025, and Winter/Spring 2026
Learning Buddies Network is designed to support students performing below grade-level expectations. Our programs are best suited to help struggling readers in Grades 1-5 and math students in Grades 3-5 but could include upper intermediate students. Grade 1 students are not accepted until January 2026 of their Grade 1 school year. Our program is not equipped to meet the needs of students with highly challenging or disruptive behaviour. Enrollment is limited to those students who need the program the most.
This form is meant to be filled out by the student’s classroom teacher, not a parent or caregiver.

If you have any questions, please get in touch with our staff, at registration@learningbuddiesnetwork.com. If you experience technical difficulties or require technical assistance, please email systems@learningbuddiesnetwork.com.

We'd love to help!
Please select the program your student would benefit from most. We can only offer one program (either math or reading) per student each term. However, students are able to register for the other program in subsequent terms:*

Reading BuddiesMath Buddies
Which type of program would benefit the student most?*

OnlineIn-PersonBoth

Overall Suitability for Programs
Learning Buddies Network is dedicated to providing support through 1-on-1 mentoring and tutoring to students that need extra support. Our Math Buddies program is designed for children working at a grade level of 3-5, and our Reading Buddies program supports children reading at a grade level of 1-5.

Our programs target students at least one grade level behind, who may struggle with confidence and can’t get extra support elsewhere. Our buddies are reviewed on a case-by-case basis, and your referral is an important resource in learning how to best support each buddy and help those that need it the most.
With this in mind, do you think this student is a good fit for our programs, and would benefit from registering in Learning Buddies sessions?*

YesNoOther/Unsure
Thank you for all your support of our programs. Without teachers like you, we could not support children who need our services most.

Sincerely,
Owen Fan, Executive Director
owen@learningbuddiesnetwork.com
Should be Empty:

	1 - Low	2 - Below Average	3 - Same as Peers	4 - Above Average	5 - High
Current confidence as a reader
Current participation in class
Current behaviour in the classroom

	1 - Low	2 - Below Average	3 - Same as Peers	4 - Above Average	5 - High
Current confidence to engage in math
Current participation in class
Current behaviour in the classroom

	1 - Low	2 - Below Average	3 - Same as Peers	4 - Above Average	5 - High
Current self esteem
Current social connectedness with peers

LBN Buddy Referral Form