New Reading Tutoring Student Form

New Reading Tutoring Student Form

Please complete this form to help me understand your child’s reading strengths, challenges, and learning needs. This information supports individualized Orton-Gillingham–based instruction. All responses are confidential.
Student Information
Student Name*
Date of Birth*
Current Grade*
Parent/Guardian Information
Name*
Relationship to Student*
Phone Number*
Email*
Scheduling
Preferred Tutoring Times/Days*
Current Reading Level
Not SureBelow grade levelAt grade levelAbove grade level
Notes about reading level (optional)
Areas of Concern
Letter recognitionLetter-sound relationshipsPhonemic awarenessDecodingEncoding (spelling)FluencyReading ComprehensionVocabularyConfidenceMotivation
Other:
Academic & Developmental Information
NoneDyslexiaADHD/ADDProcessing disorderSpeech/language delay
Other:
Goals for Tutoring
What are your goals for tutoring?*
What literacy skills is your child currently learning?*
Anything else I should know to support your child?
Should be Empty:

Student Information