YesNo

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Work Phone

Phone Validation Error Message

Participation Permission

I give permission for my child to receive one-on-one tutoring from Reading Partners.

YesNo

I give permission for Reading Partners to administer a literacy assessment to determine my child’s literacy needs and measure their progress for the duration of their enrollment.

YesNo

I give permission to Reading Partners to share personal information about my child and student records related to the program (attendance and test scores) back to the school and/or district to report on program effectiveness.

YesNo

I give permission to Reading Partners and its affiliated organizations to use/reproduce/share images, videos, voice recordings, and/or stories of my child in promotional materials, including but not limited to, news, media, film, print, digital, social media and other online properties. I understand that these materials are intended to inform and inspire individuals to support he work of Reading Partners.

YesNo

I understand that enrollment in this program is a commitment and that if my student has four or more unexcused absences they may be unenrolled and their spot given to a student on the waiting list.

YesNo

My child has a cognitive IEP

YesNoI am not sure

My child can communicate in English for educational purposes

YesNo

Region ID	Region Name This field doesn't serve a technical purpose in the submission connector or form fields, but we are leaving it here for ease of troubleshooting.
Program Delivery Type RP Traditional TutorRP Connects Tutor	If the "Program Delivery Type" field doesn't get populated via the URL as it normally should (e.g. in the event the URL gets adjusted by the form taker), our form will rely on the "I would like to" field below to capture that information. The logic of which form field to map to SF is handled in the Contact and Task connector steps.

Free Tutoring (Newark, NJ) Student Signup

Participation Permission