Reading intervention intake form

Welcome to Erika McCullough Literacy!

I'm honored to partner with your family. This form helps me understand your child's unique strengths, challenges, educational history, and goals so I can design an individualized intervention plan before our first session.

Please complete this form as thoroughly as possible. Most families finish in approximately 15–20 minutes.

Confidentiality Notice: The information you provide is used solely for planning and delivering literacy intervention services for your child. It will be treated as confidential and shared only with your permission or as required by law.