Application form: Call for available dates/times (510) 524-6455
Enclose payment with application form. Fees, including non-refundable deposit of $100, due by May 15th
Please copy form or attach separate sheet to list additional classes.
Mail to: REACH for Learning, 1221 Marin Ave., Albany, CA 94706
Student _________________________ Grade (entering)___ B. D. _____ School________________________________
Parents ___________________________ Home Address __________________________________________________
Street City Zip
Phone: Day ( ) ________ Eve. ( ) ________ Optional subject assessment _______ Full Evaluation_____
(Call to schedule)
Group or Individual _______ Class/Subject _______________________ Dates/Times ___________________________
Group or Individual _______ Class/Subject _______________________ Dates/Times ____________________
Group or Individual _______ Class/Subject _______________________ Dates/Times ___________________________