Reading Clinic Application Form

Tutoring occurs each fall and spring semester.

Please fill in all the blanks on this form
Child's Name:  
Current Grade Placement:
School Child Attends:  
Child's Date of Birth:
Parent's or Guardian's Full Name:  
Mailing Address:  
Zip Code:  
Home Phone:
Cell Phone:
Parent's E-mail:  
Has your child ever attended our program?
If yes, when?
Do you think your child is reading
Explain, as thoroughly as you can, your concerns about your child's reading skills:
Your child with their tutor, may be photographed while in the reading clinic. These pictures may be shown to diverse groups such as: the Board of Regents, accreditation teams, and other students for the purpose of showing our undergraduates working with children in the Northern State University Reading Clinic. At no time will your child be identfied by name; however I must make you aware of these photographs.
Scheduled Times - You will be sent a letter of acceptance prior to the start date.
All times are Central Standard Time (CST).
Monday & Wednesday

Tuesday & Thursday

NSU Reading Clinic is non-profit. At present, the clinic operates primarily with tuition fees paid; therefore, we ask that you pay $80.00 for the tutoring sessions on the first day of tutoring. Please make checks payable to the NSU Reading Clinic.