1-3 Literacy Outreach Recommendation Form

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This program is SPECIFICALLY for children who are reading at the first through the third grade level and are at least two grade levels behind. In addition, due to the accelerated nature of our program, we ask that you please recommend students that you believe will attend the sessions consistently and punctually. Our teaching candidates participate in this as part of of their class and depend on the children to complete their master's degree. If the student you have in mind meets these requirements, please complete and return the following information.

****ONLY TEACHERS MAY COMPLETE THIS FORM****

I truly consider that the student I am recommending has the discipline and support to be punctual and consistent in their attendance each week of the program. I understand that if my honest answer is "no", that I should not recommend the child for the program in consideration of the teacher candidates' progress in their master's program. *

Yes

Child's Name *

Child's Reading Grade Level *

Child's Current Grade *

Date of Birth *

YYYY

School *

School District *

Teacher Name

Teacher Email

Have the child’s parents/guardians been notified of your recommendation? *

Yes

Parent/Guardian Name (s) *

Home Phone *

Cell Phone *

Parent Email *

City, State, Zip Code *

Is the child in Special Education, including RSP or SDC? (If yes, please specify) *

Is the child an English Language Learner (ELL)? (If yes, please specify) *

Please explain the basis of your recommendation with as much information as possible. *

I understand that my recommendation does not guarantee a child’s placement in the Literacy Outreach program and that the CNLW determines whether the child meets state guidelines for them to be instructed by the teacher candidates. Furthermore, I understand that the CNLW maintains a waiting list, and though the CNLW does its best to ensure timely placement for all children on the list, the number of students brought in from the list is solely determined by the number of teacher candidates enrolled in each class. *

I understand and accept these terms

I do not understand and accept these terms

Submit

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