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Waitlist Application
Click here to register for Pre-K & Kindergarten
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Please enable JavaScript in your browser to complete this form.
Student Name - First and Last
*
Student Age
*
Student Date of Birth
*
Student Gender
*
Male
Female
Current Grade
*
Student Address, including Apt #, City, and Zip Code
*
Student School
*
Does he/she have any siblings enrolled in the NHR tutoring program?
*
If the answer to the last question is yes, please list:
Preferred Day and Time for Tutoring
*
Has he/she ever been retained?
*
Yes
No
If yes what grade?
Does he/she receive special services at school?
*
If yes, describe:
Please include any additional information that may affect his/her academic progress:
Do you have a computer at home with internet connection?
*
Yes
No
What is the primary language spoken at home?
*
Primary Person Student Lives With - First and Last Name
*
Relationship to Student
*
Email Address
*
Best Contact Number
*
Best Way to Contact Me
*
Phone Call
Text Message
Email
Please upload your student's most recent school issued report card, not a PowerSchool report.
*
Click or drag a file to this area to upload.
Please read the Parent Acknowledgment.
I understand:
The New Haven Reads (NHR) program is for children who are struggling with reading.
My child will be added to the waitlist on the date I submit a completed waitlist application form AND a copy of his/her most recent report card.
I am responsible for making sure that my phone numbers are current.
NHR fills openings based on the date a child is entered on the waitlist. When space becomes available for my child, NHR will attempt to contact me using the phone numbers I have provided.
If I do not respond within the time frame indicated in the message, the space will be offered to another child.
After three unsuccessful attempts to offer my child placement in the program, NHR will remove my child from the waitlist.
*
Yes, I agree to the Parent Acknowledgement and I understand the waitlist policy.
Submit