Student Referral form

*This form must be completed by students teacher.

The Children’s Literacy Center, a private non-profit community organization, provides individual assistance to students who are reading below grade level, between 1st and 6th-grade reading level.

Enrollment is available at no cost to families.

Students must meet the guidelines listed below to qualify for enrollment.

Complete one form for each student.

To qualify, students must:

  • Complete the first semester of first grade.
  • Be reading below their current grade level.
  • Not be on an Individual Education Plan (IEP) or receiving instruction for a specific learning difference to include Dyslexia.
  • Demonstrate age appropriate behavior conducive to a volunteer environment.

The student's parent/guardian must also be committed to the parent requirements and return the Parent Commitment Form to our office.


Teacher, please assess the student's overall abilities and skills by checking the appropriate space below: 

Reading fluency
Decoding skills/Word analysis
Comprehension
Sight-vocabulary
Writing
Is English spoken in the home?