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Enrollment Form
Please complete and submit the following form. Once Little Reading Coach receives it, we will send you an email to schedule a time for a Zoom chat session. If you have any questions, please send an email to
littlereadingcoach@gmail.com
.
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* Indicates required question
Email
*
Your email
Parent/Guardian Name
*
Your answer
Student's Name
*
Your answer
Student's Grade
*
Your answer
Student's Address
*
Your answer
Cell Phone Number
*
Your answer
Does the student have an IEP or 504?
*
Yes
No
What services are you interested in?
*
Virtual Tutoring Grades 6-12
Virtual Homeschooling (Reading and Writing) Grades 6-12
Virtual Reading Assessments
Virtual Writing Assessments
Required
When are you looking to start?
*
MM
/
DD
/
YYYY
How often would sessions take place?
Weekly
Twice a week
More than twice a week
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How did you hear about Little Reading Coach?
*
Your answer
Where does the student go to school?
*
Your answer
Has the student been tutored before?
*
Yes
No
What are you hoping Little Reading Coach can do for the student?
*
Your answer
A copy of your responses will be emailed to the address you provided.
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