Student Referral Form

(This form must be completed by student’s teacher)

The Cañon Literacy Center is a private, non-profit, community organization. Our volunteer tutors use the Peak Reader ® Curriculum to provide individual tutoring to students in grades 1-6 who are reading below grade level.

Enrollment is available at no cost to the families or school system.

In order for us to best serve the needs of our students, we ask that each meet the guidelines listed on this student referral form.

Fill out one form for each student who qualifies and return to our office or submit on-line.

To qualify, students must be:
• At least a second semester first grade reader.
• A student reading below their appropriate grade level.
• Not currently enrolled in an IEP or any special education programs.
• Demonstrating age appropriate behavior conducive to a volunteer environment.

The student's parent(s)/guardian(s) also must be committed to the parent requirements and must return the Parent Commitment Form to our office or submit on-line.

Fill out my online form.