Teacher Referral Form 2025/26 Academic Year

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

This application is intended solely for teacher referrals to TLC's Tutoring Program. Please note that tutoring services are limited to English literacy only.

When referring a student, please keep in mind that tutor matching depends on several factors, including volunteer availability. As a result, we cannot guarantee placement for all applicants.

Important information for the 2025/2026 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!
Before referring a student to our programs, please ensure that you have contacted the family. Once the referral is received and the parent has completed the tutoring application, we will follow up with the family to discuss the details of our tutoring program and begin the process of matching the student with a tutor
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

Student's Name*

First NameLast Name

School *

Student's Grade*

Current F&P Level *

Priority (1 being the highest)*

Our one-on-one tutoring program depends on volunteer and student availability and prioritizes students based on academic need. Due to high demand, there is often a waitlist. To support more students, TLC will offer Staff-Led Small Groups starting January 2026. Would you recommend this student to participate in a small group?*

YesNo

What is the student's attitude towards reading?

What is your student's attitude towards writing?

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

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

Additional comments (if necessary):

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

TLC Teacher Referral for Tutoring