Reading Clinic Application Form
Tutoring occurs each fall and spring semester.
Please fill in all the blanks on this form
Current Grade Placement:
School Child Attends:
Child's Date of Birth:
Parent's or Guardian's Full Name:
Has your child ever attended our program?
If yes, when?
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).
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.