Harrisburg School District
Parent Request for Supplemental Services
Name of Student: ______Student ID: ______
Name of Parent: ______Grade: ______
Dear Parent / Guardian:
Your child may be eligible to receive free supplemental services from a state approved agency, if your child is enrolled in a school that has not made Adequate Yearly Progress (AYP) for three or more provider. Listed below are the providers that have been approved by the state and are reasonably close to the school or accessible via technology. Please complete the section below and return the entire form to the school. Please use a separate form for each child for whom you are requesting supplemental services. Please return this form to your child’s school.
School Name: ______Attention: ______
Address: ______City: ______State: ____ Zip: ______
Parent/Guardian: Please complete the section below and return the entire form to school.
I understand that my child may be eligible to participate in free supplemental services. Based on this information, I have selected the following option:
I decline supplemental services for my child.
I wish to enroll my child in the services offered by the following provider from the providers listed. Please select your provider below.
SES Provider / Contact Name / Address / Phone□ / 1 in Learning Online / Brandon Edwards / 10600 Sepulveda Blvd. Ste. 107 Mission Hills, CA 91345 / (866) 698-6537
□ / 1 in Learning / Brandon Edwards / 10600 Sepulveda Blvd. Ste. 107 Mission Hills, CA 91345 / (866) 698-6537
□ / A Plus Success / Yohannes Woldehanna / 5501 Cherokee Ave #201 Alexandria, VA 22312 / (703) 566-9533
□ / AAVANTE / Deborah Farnoush / 21781 Ventura Blvd., Suite #418 Woodland Hills, CA 91364 / (818) 400-1076
□ / Above and Beyond Learning, Inc. / Alejandro Regalado / 1243 SW 143 Ct Miami, FL 33184 / (305) 499-9333
□ / academic excellence mce tutoring / tawnya martin / 2011 COLONY DRIVE HOPEWELL, PA 15001 / (724) 709-4534
□ / Academic Networking Educational and Tutoring Services / Regina Isaac / PO Box 1526 Dayton, OH 45401 / (937) 219-0387
□ / ACES / Bayeh Thompson / 6401 Elmwood Avenue Center in the Park Phila., PA 19142 / (267)591-9433
□ / ACES Tutoring / Lauren Foley / P.O. Box 418 Gotha, FL 34734-418 / (407) 279-2520
□ / Achieve HighPoints from Datamatics, Inc / Carol Simmons / 905 Chester Avenue Yeadon, PA 19050 / (215) 760-1857
□ / Achievement Matters / Deborah Farnoush / 21781 Ventura Blvd., Suite #418 Woodland Hills, CA 91364 / (818) 400-1076
□ / AMERICAN TUTOR, INC / James Wegeler / 2 Ilene Court Bldg 1, Suite 16 Hillsborough, NJ 8844 / (908)281-0050
□ / Arline Institute, Inc. / Tyrone Pitts / 1100 East State Street Camden, NJ 8105 / (856) 583-1130
□ / ATS Project Success / Melinda McNeill / 20674 Hall Rd. Clinton Township, MI 48038 / (586) 465-9474
□ / Attain Learning Centers / Michael Zarreii / 608 Market St. New Cumberland, PA 17070 / (717) 730-7070
□ / Beaver Valley Intermediate Unit / Marianne LeDonne / 147 Poplar Avenue Monaca, PA 15061 / (724) 774-7800
□ / Boys Girls Club of Western PA / Terri Henderson / 5432 Butler Street Pittsburgh, PA 15201 / (412) 782-5710-115
□ / Bright Light Education / Rhonda Sumter / 43 Eastern Parkway, Fl. 1 Jersey City, NJ 7305 / (201) 345-7135
□ / Catapult Learning, LLC / Bill Backall / 2 Aquarium Drive Suite 100 Camden, NJ 8103 / (856) 831-7918
□ / Christianson Tutorials, LLC / John D. Christianson / 233 Hopewell Drive Allentown, PA 15201 / (412) 782-5710
□ / Church of St. Andrews and St. Monica / Patricia Hines / 6101 Morris Street Unit 113 Philadelphia, PA 19144 / (215) 482-1238
□ / Club Z In-Home Tutoring Services, Inc. / Cari Diaz / 15310 Amberly Drive Suite 110 Tampa, FL 33647 / (888) 434-2582
□ / Club Z Tutoring / Nina Pinsley / 3140 B Tilghman Street, #132 Allentown, PA 18104 / (610) 351-3500
□ / Colosseum Inc DBA Club Z In- Home / Annette Chilleri / 3614 ½ Winfield Ave. Moosic, PA 18507 / (570) 824-4044
□ / Earthen Vessels Outreach / Marilyn Chaney / 4740 Friendship Ave. Pittsburgh, Pa 15224 / (412) 414-2993
□ / Educate Online / Joanna Smith / 1001 Fleet Street 8th Floor Baltimore, MD 21202 / (410) 843-2672
□ / Education Futures Corp. / Karlton Roberts / 2600 Philmont Avenue Suite 311 Huntingdon Valley, PA 19006 / (215) 938-8899
□ / EducationWorks / Elise Schiller / 3149 Germantown Avenue Philadelphia, Pa 19133 / (267) 575-7101
□ / FIRST AID TUTORIAL SERVICES LLC / Khalifah Shabazz / 17 Academy St. Ste 305 Newark, NJ 7102 / (866) 918-3224-206
□ / Foundations, Inc / Glenna Deekle / 2111 Eastburn Avenue Philadelphia, PA 19133 / (267) 297-6321
□ / Huntington Learning Center / Peggy Holmes / 496 Kinderkamack Road Oradell, NJ 7649 / (800) 692-8400-513
□ / ICON DESIGNERS LLC / Partha Denath / 3002 Canard Dr. Phoenixville, PA 19460 / (267) 577-5559
□ / Innovative Educational Programs,LLC d/b/a Learning Alliances / Gerry Galderisi / 287 Childs Road Basking Ridge, NJ 7920 / (908) 630-9600
□ / Kanmas Educational Support Center / Sylvanus Wosu / 5100 Penn Avenue Pittsburgh, PA 15224 / (412) 894-8595
□ / KnowledgePoints / Keith Bocian / 2316 Garrett Road Drexel Hill, PA 19026 / (610) 626-3100
□ / Learning Ladder, Inc / Lucia Vega / 111 5th Street Gilroy, CA 95020 / (800) 207-3415
□ / Learn-It Systems, LLC / Stephanie Suerth / 3600 Clipper Mill Road Suite 330 Baltimore, MD 21211 / (410) 369-0000-124
□ / Michael Anderson Learning / Michael Anderson / 1016 Cardinal Lane Cherry Hill, NJ 8003 / (267) 718-7300
□ / Mobile Minds Tutoring / Sheyna Land / 1125 NW 12th Ave. #709 Portland, OR 97209 / (877) 496-4637-31
□ / New Kingdom Baptist Church / Patricia Hines / 6101 Morris Street Unit 113 Philadelphia, PA 19144 / (215) 482-1238
□ / Northwest tri-County intermediate Unit / Della Gentile / 252 Waterford St. Edinboro, PA 16412 / (814) 734-5610-8458
□ / One on One Learning / Arlene Kraus / 8900 SW 117th Ave. Suite C-103 Miami, FL 33186 / (305) 273-8999
□ / One On One Tutoring Service, Inc. / Thaddeus Falana / 6122 Germantown Avenue Philadelphia, PA 19144 / (215) 482-1238
□ / Overbrook Learning Center / Fred Boccella / 7708 City Line Avenue 2nd floor, Suite Philadelphia, PA 19151 / (215) 877-8801
□ / PeeWeePrep Educational Center / Stacy Gill / 251 N 56th Street Philadelphia, Pa 19139 / (215) 768-1300
□ / Pittsburgh Prep / Sunghoon Kim / 134 S. Highland Ave 3rd Floor Pittsburgh, PA 15206 / (412) 468-5833
□ / Promises, Inc. dba Easy In-Home / Joseph T. Slavitskas / 504 Sunset Drive Olyphant, PA 18447 / (570) 341-7400
□ / Quadrant Thinking / Lorenzo McFadden / 617 Stokes Rd. Suite 4-103 Medford, NJ 8055 / (609) 254-5774
□ / Reading Now, LLC / Chad Bentley / 3910 Caughey Road Suite 120 Erie, PA 16506 / (814) 833-2223
□ / Regional Enrichment and Learning / Barbara Donahue / 1317 Chew Landing Road Laurel Springs, NJ 8021 / (856) 232-7325
□ / Rocket Learning / Clayvi Rodriguez / 1000 Park Centre Blvd suite 112 Miami, FL 33169 / (646) 784-5602
Scholarship In Progress / Patricia Hines / 6101 Morris street Unit 113 Philadelphia, PA 19144 / (215) 482-1238
□ / Smarties Tutoring Services / Isaak Aronson / 59 Elm Street Suite 330A New Haven, CT 6510 / (203) 772-4331-305
□ / Stay On Top Tutoring Services Inc. / Arthur Swain / 558 N 16th Street Apt#1 Philadelphia, PA 19130 / (215) 242-1141
□ / Success Tutoring LLC / Cassandra Poles-Johnson / 59 Coachlight Dr Sicklerville, NJ 8081 / (215) 908-5517
□ / Supplemental Education Services, Inc / Adam Richards / 422 W Washington Blvd Grove City, PA 16127 / (800) 518-8867
□ / Sylvan Learning / Randy Rohde / 34305 Solon Rd Solon, OH 16148 / (440) 991-6717
□ / Sylvan Learning Center- Hermitage / Holly Baldarelli / 495 South Hermitage Road Hermitage, PA 16148 / (724) 346-6284
□ / Sylvan Learning Center Chambersburg / Amanda McNew / 1976 Scotland Avenue Chambersburg, PA 17201 / (717) 263-0671
□ / Sylvan Learning Center of Erie/NBM / Dawn R. Walton / Summit Towne Centre 7200 Peach Street Erie, PA 16509 / (814) 864-6100
□ / Sylvan Learning Center Hollidaysburg / Curt Costlow / 721 North Juniata Street Hollidaysburg, PA 16509 / (814) 693-1030
□ / Sylvan Learning Center Lancaster / Aimee Bergner / 1864 Fruitville Pike Lancaster, PA 17601 / (717) 293-0300
□ / Sylvan Learning Center of York / Sarah Mock / 2300 E. Market Street York, PA 17402 / (717) 840-9600
□ / Sylvan Learning Center/ Ace It! / Curt Costlow / 100 North Mountain Rd Harrisburg, PA 17112 / (814) 262-9665
□ / Sylvan Learning of Harrisburg / Melissa McGruther / 1100 North Mountain Road Harrisburg, PA 17112 / (717) 652-0646
□ / Sylvan Learning Center Palmyra / Aimee Bergner / 1200 E Main Street Suite 1 Palmyra, PA 17078 / (717) 838-2650
□ / Sylvan Learning Center of the Lehigh Valley / Elizabeth Babbin / 1104 Van Buren Road Easton, PA 18045 / (610) 250-7110
□ / Sylvan Learning Center/ Ace itState College / Curt Costlow / 2134 Sandy Drive State College, PA 16803 / (814) 262-9665
□ / The EARTHS / Quibila A Divine / 3414 North 19th Street Philadelphia, PA 19140 / (215) 225-7241
□ / The Learning Lamp / Heidi Rizkalla / 2025 Bedford Street Johnstown, PA 15904 / (814) 262-0732
□ / The RIght Prep, LLC / Tawanda Lane / 12008 NW 13th Street Pembroke Pines, FL 33026 / (301) 288-7830
□ / Today'sChild Learning Center / Robert D. Auritt / 1016 Maple Avenue Sharon Hill, PA 19079 / (610) 583-2273-107
□ / TutorFind / Louis Dion / P.O. Box 1861 Ashburn, VA 20146 / (703) 881-1675
□ / Tutorial Services / Kristie Schaufele / 166 S. Industrial Dr. Saline, MI 48176 / (734) 470-6387
□ / Youth Enriched Academic Resources Of PA / Lauren Zimmerman / 166 Plymouth Drive Depford, NJ 8096 / (215) 728-7700
I will require assistance from the school to help me make a choice. Please contact me at the phone number and/or email address listed below.
Signature of Parent/Guardian: ______
Address: ______City: ______State: ____ Zip: ______
Telephone: ______Email: ______
NCLB-D2-Parent Request for Supplemental Services-Revised 8/12 2101 N. Front St. Harrisburg, PA 17111