Baby Raven Reads Enrollment
Baby Raven Reads is a kindergarten readiness program promoting language development and literacy skills for Alaska Native families with children up to 5 years old or who are not yet enrolled in kindergarten.
A separate form must be completed for each child to enroll in the program.
Responses on this form will be kept confidential and used only for program purposes.
Limited space available--completion of this form does not guarantee placement in the program.
By submitting this form, you are signing up to participate in Baby Raven Reads events, reading attitudes surveys, feedback surveys, and to receive monthly mail. Be sure to submit a primary mailing address. We will mail literacy kits October through May. Please contact us if your address changes.
babyravenreads@sealaska.com
http://www.sealaskaheritage.org
* Required
Child's last name
*
Your answer
Child's first name
*
Your answer
Child's age
*
Your answer
Child's date of birth
*
MM
/
DD
/
YYYY
Child's gender
*
Male
Female
Estimated graduation date from Raven Reads program (date child will enter kindergarten)
*
MM
/
DD
/
YYYY
Mailing Address (PO Box or address where you receive mail)
*
Your answer
City
*
Angoon
Craig
Haines
Hoonah
Hydaburg
Juneau, Auke Bay, or Douglas
Kake
Ketchikan
Klawock
Klukwan
Metlakatla
Petersburg
Saxman
Sitka
Wrangell
Yakutat
Zip Code
*
Your answer
Primary contact's email address
*
Your answer
Primary contact's phone number
*
Your answer
Primary contact's last name (parent/guardian)
*
Your answer
Primary contact's first name (parent/guardian)
*
Your answer
Child's tribal affiliation
*
Tlingit
Haida
Tsimshian
Other:
Required
Which of the following best describes how often someone in your household reads to your child in an average week?
Daily
A few times a week
Weekly
Less than weekly
Don't know
Clear selection
How often does your child engage in the following behaviors?
*
Always
Most of the time
Sometimes
Rarely
Never
Don't Know
Asks to be read to
Pays attention while being read to
Participates positively in group activities
Remembers and connects experiences
Recognizes letters and symbols
Recognizes letter and word sounds
Demonstrates knowledge or awareness of print throughout their day
Uses words or gestures to communicate their wants or needs
Follows basic directions
Regulates feelings and impulses
Shows curiosity in learning new things and experiences
Sustains attention to tasks and persists when facing challenges
Uses Lingít, X̱aad Kíl or Sm'algya̱x language
Always
Most of the time
Sometimes
Rarely
Never
Don't Know
Asks to be read to
Pays attention while being read to
Participates positively in group activities
Remembers and connects experiences
Recognizes letters and symbols
Recognizes letter and word sounds
Demonstrates knowledge or awareness of print throughout their day
Uses words or gestures to communicate their wants or needs
Follows basic directions
Regulates feelings and impulses
Shows curiosity in learning new things and experiences
Sustains attention to tasks and persists when facing challenges
Uses Lingít, X̱aad Kíl or Sm'algya̱x language
Voluntary information; Is your child enrolled in:
Day care
Preschool
Headstart
Kindergarten
Other:
Please provide the name(s) of any other children enrolled in Baby Raven Reads living in your household (if any):
Your answer
Are you interested in being a parent helper in your community?
*
Yes
No
Maybe
Participation agreement
*
Baby Raven Reads requires participation from those enrolled in the program for events and surveys.
I agree to participate in Baby Raven Reads:
Program events
Reading attitude surveys
Program feedback surveys
Kindergarten readiness assessments
I agree to participate in Baby Raven Reads:
Program events
Reading attitude surveys
Program feedback surveys
Kindergarten readiness assessments
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