Clone of Teacher Referral Form 2026/27 Academic Year

Thank you for taking the time to complete this referral form and review the information provided.

This form is intended for teacher referrals to TLC's Tutoring Program. Please note that tutoring services are available for English literacy support only.

When referring a student, please keep in mind that tutor matching depends on several factors, including volunteer availability. While we strive to serve as many students as possible, we cannot guarantee placement for every applicant.

Important information for the 2026/2027 Academic Year:

Tutoring enrollment will take place from July 31st 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

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 2027. Would you recommend this student to participate in a small group?

What is the student's attitude towards reading?

What is your student's attitude towards writing?

Reason for referral: Please describe the student's academic strengths, challenges, and areas where tutoring or enrichment would be beneficial.

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

TLC Teacher Referral for Tutoring