Summer Program Placement Request 🌞
Complete the form to initiate your child's placement process for the summer literacy program.
Student Name
*
Age
*
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
Additional insight (optional)
Program Details
Program Tuition: $7,000 (6-week program)
Registration & Onboarding Fee: $300; includes initial placement screening, student profile review, program preparation and instructional planning
Placement/enrollment process includes review of submitted form, brief placement screening, group placement confirmation, final enrollment and scheduling
Program structure: Personalized 1:1 instruction, consistent schedule Monday through Thursday, 8:30–12:30 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
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