ENMU Language and Literacy Studio - Application for Children Attending

Child's name Child's name First Last
Child's date of birth Child's date of birth / MM / DD YYYY
Child's current grade
Child's current school
Parent/guardian name Parent/guardian name First Last
Parent/guardian phone Parent/guardian phone - ### - ### ####
Parent/guardian email
Emergency contact other than parents Emergency contact other than parents First Last
Emergency contact phone Emergency contact phone - ### - ### ####
What is your child's current reading level? Please ask your child’s teacher, if you do not know.
What is child's home language? ¿Cuál idioma hablan en el hogar?
Does your child have an IEP or 504 plan?

Does your child have an IEP or 504 plan? Yes No
Are there any dates that your child will NOT be attending the Reading and Learning Academy? Please list the dates.

Are there any dates that your child will NOT be attending the Reading and Learning Academy? Please list the dates. Yes No
Please list the dates
Please share questions or important additional information you would like us to know