45 Bristol Street, New Haven, CT 06511 information@newhavenreads.org 203-752-1923

Waitlist Application

    Before you begin, please note that you must attach a photo or scanned copy of your child’s official report card to submit a complete application.

    Student Information
    Date (required):
    Student’s Name (required):
    Address (required):
    City (required):
    Zip Code (required):
    Date of Birth (required):
    Age (required):
    Gender (required):
    School (required):
    Current Grade (required):
    Does he/she have any siblings enrolled in the NHR tutoring program? (required)
    If yes, please list:
    Preferred Day for Tutoring:
    Preferred Time:
    Has he/she ever been retained? (required)
    If yes, what grade?
    Have you received notification that he/she will be retained? (required)
    Does he/she receive special services at school? (required)
    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?
    What is the primary language spoken at home? (required)

    Guardian Contact Information

    Primary person student lives with (required):
    Relationship to student (required):
    Home Phone:
    Cell Phone (required):
    Email Address (required):

    Report Card

    Please note that you MUST submit a copy of your child’s most recent report card to join the Waitlist. If you cannot attach a photo or scanned copy at this time, you may bring the report card to NHR at 45 Bristol St, New Haven, CT during our open hours.

    Parent/Guardian Signature (required):
    Date (required):