A Little Lit

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A Literacy Program for Young Readers

To apply for tutoring, please complete this questionnaire

for a response within 48 hours.

Name*

Phone

Email Address*

Name of Child

Age of Child

6-78-910-1112

Child's Grade

1st-2nd3rd-4th5th-6th

At what grade level is your child currently reading?

In what areas would you like to see improvement?

Phonemic AwarenessFluencyPhonicsReading ComprehensionVocabularyWriting

Have you previously worked with a tutor?

YesNo

Does your child have an IEP?

YesNo

Are you most interested in group or individual tutoring?

GroupIndividualI'm not sure

What is your availability for tutoring?

Monday 4:00-5:00Monday 5:00-6:00Tuesday 4:00-5:00Tuesday 5:00-6:00Thursday 4:00-5:00Thursday 5:00-6:00Saturday 9:00-10:00Saturday 10:00-11:00

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