After-School Tutoring Program Application
To have your child considered for your program, please fill out the interest form below.Return this form to America Reads at NAU College of Education, Box 5774, Flagstaff AZ 86011 or by fax, 928.523.1168, or email a scanned copy to or drop the form off at the Flagstaff Main Library.
America Reads tutors are students who are attending Northern Arizona University and are employed to tutor children in improving reading and math skills; we are not a homework assistance program. This program is intended for children in grades K-6. You and your child are expected to arrive on time to each session and be ready to work on related activities. Students are allowed two absences from regularly scheduled appointments. Continual absences will result in removal from this program. You might consider asking your child’s teacher for assistance in helping you to select appropriate materials.
The America Reads After-School Program is not a daycare program. Parents of children under 10 are REQUIRED to remain in the library with their children. America Reads tutors are not responsible for your child after the scheduled tutoring session has ended. If you do not pick up your child promptly when the session ends and your child remains unsupervised at the library you will be subject to the conditions of the library’s Unattended Youth and Persons with Special Needs Policy (attached).
Please indicate your preference for tutoring times below. We will do our best to provide you and your child with your first choice of times and days. For tutoring to be effective, it is required that a minimal of two days a week be requested.
Also please be aware that with the high amount of applications coming into our program, it is possible that your child will be placed on our waiting list. Our program is not structured as first come first serve, but rather the availability that is open for the tutors. Thank you so much for your patience and your continual interest in our program.
I agree to the policy stated above, and have read and understand the Unattended Youth Policy.
Parent or Guardian Signature ______Date: ______
Unattended Youth and Persons with Special Needs Policy
The library is not a child care facility and is not a safe place to leave youth and persons with special needs unattended. While library staff is concerned about safety, they cannot assume responsibility for youth and persons with special needs left unattended.
Youth under 10 years old and anyone with special needs who requires a caregiver must have supervision at all times while in the library by someone age 14 or older. If the person in charge needs to go into areas of the library other than Youth Services, youth fewer than 10 or persons with special needs must go with them. Puzzles and books may be taken into other areas of the library as long as they are returned to Youth Services.
If a youth less than 10 years old or anyone with special needs who requires a caregiver is found unattended, staff will attempt to locate the person in charge. If no one can be
located, the Flagstaff Police Department will be called.
If a youth less than 10 years old or a person with special needs who requires a caregiver is attending a special program or story time, the person in charge must remain in the building.
Youth between the ages of 10 and 12 should not be expected to remain unsupervised for longer than one hour. Young people are expected to comply with all behavior policies. Behavior policies are posted throughout the library.
Youth and persons with special needs must be picked up by closing time. If a youth or person with special needs is left unattended after closing hours and a parent/guardian cannot be reached, library staff will contact the Flagstaff Police Department.
Applicant Information
Parent/Guardian:Last / First / M.I.
Home Phone: / ( ) / Cell Phone: / ( )
Work Phone: / ( )
Child’s Full Name:
School: / Last First M.I.
Grade:
Please indicate your preference for tutoring times
Monday / Tuesday / Wednesday / Thursday3:30-4:30
4:30-5:30
5:30-6:30
other
What other areas does your child need help with? (please check all that apply)
☐ / Reading/Phonics / ☐ / Reading/Comprehension / ☐ / Reading/Fluency
☐ / Writing / ☐ / Math / ☐ / Other
Does your child enjoy reading books independently?
☐ / Always / ☐ / Sometimes / ☐NeverDoes your child enjoy reading books to others? (Younger children, siblings, parents, etc.)
☐ / Always / ☐ / Sometimes / ☐NeverHow many days a week does your child read at home?
☐ / 0 / ☐ / 1-2 / ☐ / 3-4 / 4+☐ / 5+
Does your child have books at home?
☐ / Yes / ☐ / No
Please explain your child’s current reading abilities. (i.e., grade level, comprehension, fluency, etc.)
Are there any known learning disabilities preventing your child from learning at grade level?
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