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Thank you for your interest in our virtual literacy programs. Please complete the form below so we can learn more about your child and ensure they are placed in the program that best meets their needs.

After submitting this form, you will receive information regarding placement, scheduling, and next steps.

Parent or Guardian Information

Parent/Guardian Name (First, Last)*

Email Address*

Phone Number*

Preferred Method of Contact*

Phone

Text Message

Student Information

Student Name (First, Last)*

Student Age*

Student Date of Birth*

Month

Day

Year

Current Grade Level*

Program Selection

Which program are you interested in?*

Reading Intervention (Small Group)

1:1 Reading Intervention

Homeschool Program

Not sure- Please recommend a program

Reading Background

How would you describe your child's current reading level?

Significantly Below Grade Level

Slightly Below Grade Level

At Grade Level

Above Grade Level

Unsure

What reading concerns do you have?*

Letter recognition

Letter sounds

Blending sounds

Decoding words

Reading fluency

Reading comprehension

Spelling

Writing

Reading confidence

Attention during reading

No concerns

Has your child previously received reading intervention?*

Yes

If yes, please explain:

Educational Information

Does your child currently receive any of the following?*

IEP

504 Plan

Special Education Services

Speech/Language Service

Reading Intervention

None

Has your child been diagnosed with any of the following?*

Dyslexia

ADHD

Autism

Speech/Language Disorder

Learning Disability

Other

Scheduling Preferences

Preferred Session Time*

Morning

Afternoon

After School

Evening

Parent Goals

What are your goals for your child?*

Optional Documents

Upload Supporting Files (Optional)

Technology Requirements Acknowledgement

I understand my child will need:*

A computer or iPad

Reliable internet Access

Headphones (or a quiet, distraction-free room)

A small whiteboard and dry erase marker

A quiet learning space

Program Policies

Please review and acknowledge the following:

I understand classes are conducted virtually through Zoom.

I understand placement is based on age, reading level, and availability.

I understand tuition and scheduling information will be provided after placement is determined.

I understand regular attendance is important for student success.

I agree to be contacted regarding enrollment and placement.

We look forward to helping your child grow as a confident reader!

Contact

hello@readingrootsidaho.com

Our Mission

Cultivating confident readers together through student-centered virtual intervention focused on fluency and comprehension.

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