UNR Center for Learning and Literacy
SUMMER 2016 Tutoring Clinic Application
GRADES K-3
UNR education majors tutor elementary students who have difficulties learning to read and write. Children are tutored
individually and in small groups with an emphasis on developmental instruction, technology, and providing positive learning
experiences.
DATES: JULY 18th –AUGUST 4th
PLEASE NOTE THAT THE SUMMER CLL TUTORING PROGRAM HAS TWO TIME SLOTS.
PLEASE CIRCLE THE ONE YOU PREFER
GROUP 1:
GROUP 2:
Monday-Thursday
Monday-Thursday
3:15 -4:00 p.m.
4:15-5:00 p.m.
Student Information
Student’s Name
________________ Date of Birth _____________
Grade: _______ Age: _______ Circle one: (Male Female) School:_____________________________
Has your child attended our tutoring program in the past? Yes
No
If yes, when? __________________
Family Information:
Name ________________________________________________________________________
Address ____________________________City/State ___________________ Zip____________
Phone # _____________ Email _____________________________
Parent Recommendation: Please describe your child’s reading abilities and needs.
__________________________________________________________________________________________
Teacher Recommendation: Please describe this student’s reading abilities and needs.
DRA Score: _________________________MAP Score: _____________________________________
Teacher Signature_________________________________________Date_____________________________
Attendance Requirements
PLEASE NOTE: Tutoring is conducted at the UNR campus. Families are responsible for
transporting their children to and from the UNR campus tutoring site. Attendance is crucial for the
success of the program. More than 3 absences will result in your child being dropped from the
tutoring program. No refunds are given for students being dropped from tutoring due to lack of
attendance.
Sign here to accept attendance policy _______________________Date________________
_____________________________________________________________________________________________
Payment & Scholarship Information
The tutoring program fee is $120.00 for the summer. The CLL accepts checks and credit cards.
Please indicate your preferred payment method by checking the following:
MasterCard ___ Visa ___ Discover ___ American Express ____Check No.____
The week prior to tutoring you will be informed of your child’s acceptance and asked to provide payment
over the phone. Please sign below to indicate that you are willing to pay the $120 fee. If your family
qualifies for free or reduced lunch you can provide us with a letter to be considered for a scholarship. We
accept some students for scholarship.
Signature ____________________________ Printed Name _____________________________Date________
Acceptance Notification
We receive many applications for the tutoring program. Program slots are dependent on the UNR
student course enrollment for each semester in order to maintain the one-on-one ratio. If your
child is accepted you will receive a welcome packet with additional information, other students will
be placed on a waiting list. You may contact Erica Charles if you have any questions:
echarles@unr.edu
Email the completed application form to the CLL graduate assistant Erica
Charles: echarles@unr.edu
A limited numbers of scholarships are available each semester. For additional
information please email the center graduate assistant at echarles@unr.edu
__________________________________________________________________________________________
For office use only:
Date Received:_________________ Application Complete: __________Payment Received: _________________