Teacher Referral Form

This form must be completed by the student’s teacher.

The Children’s Literacy Center, based in Colorado Springs, offers one-to-one tutoring to students who are reading below grade level at NO COST TO FAMILIES! We match each student with a community volunteer trained in the Peak Reader® Program. Tutoring sessions are one hour, twice a week, for 12 weeks during the fall and spring and six weeks during the summer. CLC also offers tutoring on Saturday mornings in some areas.

Enrollment is available at no cost to families.

Students must meet the guidelines listed below to qualify for enrollment.

Complete one form for each student.
To qualify, students must:

Have completed the fall semester of first grade and be reading between the first and sixth grade levels.
Read below their current grade level.
Not be on an Individual Education Plan (IEP) or receiving instruction for a specific learning difference, to include Dyslexia.
Speak English fluently.
Demonstrate age appropriate behavior conducive to a volunteer environment.

To ensure this form is sent to the appropriate location, teachers must select the tutoring site chosen by the parent or guardian. Once this form and the Student Enrollment Form have been submitted, your student’s name will to added to our wait list until we have an available tutor.

Student's Name(Required)
Parent's/Guardian's Name(Required)

Select the location at which the child will be tutored:

Teacher's Name(Required)

Teacher, please assess the student's overall abilities and skills by checking the appropriate space below

Reading fluency(Required)
Decoding skills/Word analysis(Required)
Is English spoken in the home?(Required)