Reading Intervention Program Intake Form - Summer
Aloha Parent/Guardian,

Thank you for your interest in our Reading Interventionist tutoring program for Summer 2023. Our summer program tutoring services are open to students in grades 1-3 who may benefit from reading tutoring.

The deadline to submit the form is April 16th, 2023. Once the intake period ends, the program committee will make decisions you should receive notice of acceptance within a few weeks after.

Submitting past the deadline will automatically place your intake in a second group of intakes that will only be considered if we do not fill all of our slots with the first group who met the deadline.

Please note that there is no guarantee your child will be chosen to participate as space is limited.

Please complete ONE intake form per child. 

Mahalo!
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Email *
Child's First Name *
Child's Last Name *
Semester interested in tutoring services *
What school is your child currently enrolled in? *
Gender *
What is your child's current grade level? *
What is your child's current reading level? (Last assessment results, if known)
Parent/Guardian's FIRST and LAST name *
Parent/Guardian's PHONE number *
Some correspondence with our program and tutors will be via phone, so please ensure the phone number provided is accurate.
Parent/Guardian's EMAIL address *
Most correspondence with our program will be via email, so please ensure the email address provided is accurate.
How do you prefer to be contacted? *
Other important/relevant information you would like to share:
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