School Referral Form

Eligibility:

  1. Child attended Circle Preschool for at least one school year.
  2. Child is reading a year or more below grade level.
  3. Child's parents agree to a Release of Information for the child's academic records, including report cards, tests, and IEP (if any).
  4. Parents agree to meet the conditions for obtaining  tutoring or other appropriate assistance.

If you would like to recommend a child, please provide the following information:

Your Name :
School:

 

 

Your Position:




Child's Name:
Grade:
Dates at Circle:

This child meets:

Have you discussed this program with the child's parents?

Did the parents ask you for a referral?

Comments: