Summer Reading Enrichment Application
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Thank you for your interest in attending the Belser-Parton Literacy Center Summer Literacy Programs! Please complete the information below in order to let us know how to best serve your child. We are offering one session that consists of 10 classes beginning June 2 and ending July 2.  Classes will meet Tuesday and Thursday for 45-minutes each day. One missed class may be made up on the make-up day July 7.
Please select which class you are interested in. *
Please rank your preferred class time *
1st Choice
2nd Choice
3rd Choice
2:30 pm
3:30 pm
4:30 pm
Please rank your preferred style (group/individual) and teacher level. *
1st Choice
2nd Choice
3rd Choice
Individual with Certified Teacher
Small Group with Certified Teacher
Individual with UA Student
Student Name *
Age *
Birthdate *
MM
/
DD
/
YYYY
2020-21 Grade Level *
School *
Parent/Guardian Name *
Phone *
Email *
What would like your child to accomplish in this program?   *
What are things your child is interested in and what types of books does he/she enjoy? (ex: animal books, baseball, dancing) *
We will conduct short, informal assessments on the first day, but give us as much information as you know. Reading Level:  ___   (AR book level?  STAR Reading test? Titles of books child can read on own, etc.) *
Letters that are known: *
Letters they can write: *
Letter sounds they know: *
Reads short words (e.g., CAT,  HOP) or special words (e.g., LOVE, MOM, etc.) *
Knows these words on sight (or approximate number if many): *
Areas of concern *
List any additional information you have attached or will be emailing to the Center: *
I understand that: 1) this application does not guarantee my child a space in the program given the need to balance the small groups, 2) no guarantee of progress can be made, 3) payment in full must be made before the first class, and that one missed class may be made up at the assigned time on the make-up day July 7th.  Please enter your full name and date. *
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