Age
*
Student Name
*
Current Grade
*
Parent/Guardian Name
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Student Learning Profile
Primary area of support
*
Reading
Writing
Both
Current reading level
*
Recognizes some letter sounds
Reads simple words (e.g., cat, map)
Reads short sentences
Reads short passages
Current writing ability
*
Copies letters or words
Writes simple words
Writes short sentences with support
Writes sentences independently
Does your child require frequent redirection during learning activities? (Learning engagement)
*
Yes
Sometimes
No
Program Details
Program Lenght: (6-week program)Â
Placement/enrollment process: Review of submitted form, brief placement screening, placement confirmation, final enrollment and scheduling
Program structure: Personalized 1:1 instruction, consistent schedule Monday through Thursday, 12:30-2:30 PM, 6-week instructional cycle
Enrollment is limited to maintain quality and effectiveness of instruction
We acept
Step Up for Students
Scholarship
I understand the program structure, investment, and placement process, and I would like to proceed with the placement request.
*
I understand the program structure, investment, and placement process, and I would like to proceed with the placement request.
Request Placement
Summer Program Placement Request 🌞
Complete the form to initiate your child's placement process for the summer literacy program.
Should be Empty: