Student Last Name: ________________________

Berea Tutoring Teacher Referral Form Date:____________ Student: _______________________________________________ Grade Level: _______ Age: ________ School: ________________________________________ Parents/Guardians: _____________________________________________________________ Phone(s): __________________________ City of Residence: ____________________________ Referring Teacher: ________________________________________________________________ Phone: _________________________ Email: _____________________________________________ Is this student receiving extra support anywhere outside of the regular classroom (ex. Intervention, Special Education, After-school tutoring, In-school tutoring, etc)? If so, where?

The goal of the tutoring program is to provide supplemental education in order to bring a student up to grade level. Our volunteers are trained and receive weekly guidance and support, but they are college students not professionals. On a scale from 1 (not at all) to 5 (life-changing), in your professional opinion how much do you think this student could benefit from an after-school tutoring program? Please comment if necessary.

Scores and Ranges (if applicable/available): MAP score (reading): ______________ MAP score (math): __________________ Lexile Range:________________ Other: ____________________ We thank you so much for taking the time to complete the attached referral forms. The information you provide will be passed on to the tutors so that they can better choose materials during the tutoring session. During the school year, if you ever have any more information to share or desire any information from us, feel free to contact the tutoring team. Our goal is to create a system of communication so that each student is receiving the most effective education possible. Please return this form to CELTS by the date requested to give our team enough time to process the paperwork and contact the parents/guardians. Thank you, Berea Tutoring Program CELTS, Berea College CPO 2170 859 985 3805

Student Last Name: ________________________

Third Grade Pre-Assessment (Adapted from the Common Core Standards. http://www.corestandards.org/) Reading/Writing Part One: Place a “P” next to specific skills which the student is able to do at a proficient level. Place a “NW” next to skills that would be beneficial for the student to practice. Leave unobserved skills blank. Phonics __ Use and apply K-2 standards for phonics. [Please leave comments if this needs work.] __ Identify and know the meaning of the most common prefixes and derivational suffixes. (RF.3.3.A) __ Decode words with common Latin suffixes. (RF.3.3.B) __ Decode multi-syllable words. (RF.3.3.C) __ Read grade-appropriate irregularly spelled words. (RF.3.3.D) Fluency __ Use and apply K-2 standards for fluency. [Please leave comments if this needs work.] __ Explain how specific aspects of a text's illustrations contribute to what is conveyed by the words in a fiction or non-fiction piece of text. (RL.3.7; RI.3.7; RI.3.5) __ Read grade-level text with purpose and understanding. (RF.3.4.A) __ Read grade-level prose and poetry orally with accuracy, appropriate rate, and expression. (RF.3.4.B) __ Use context to confirm or self-correct word recognition and understanding, rereading as necessary. (RF.3.4.C) Vocabulary __ Use and apply K-2 standards for vocabulary. [Please leave comments if this needs work.] __ Use sentence-level context as a clue to the meaning of a word or phrase. (L.3.4.A) __ Determine the meanings of unknown words by using root words and affixes. (L.3.4.B; L.3.4.C) __ Use glossaries or beginning dictionaries to determine or clarify the meaning of words and phrases. (L.3.4.D) __ Distinguish the literal and nonliteral meanings of words and phrases in context (e.g.,take steps). (L.3.5.A; RL.3.4; RI.3.4) __ Distinguish shades of meaning among related words that describe states of mind or degrees of certainty (e.g., knew, believed, suspected, heard, wondered). (L.3.5.C) Comprehension __ Use and apply K-2 standards for comprehension. [Please leave comments if this needs work.] __ Ask and answer questions to demonstrate understanding of a text. (RL.3.1; RI.3.1) __ Refer to parts of stories, dramas, and poems when writing or speaking about a text, using terms such as chapter, scene, and stanza (RL.3.5) __ Recount key details of stories and non-fiction text. (RL.3.2; RI.3.2) __ Determine the central message or main idea and explain how it is conveyed. (RL.3.2; RI.3.2) __ Describe characters in a story (e.g., their traits, motivations, or feelings) and explain how their actions contribute to the sequence of events. (RL.3.3) __ Distinguish his own point of view from that of the author, narrator or those of the characters. (RL.3.6; RI.3.6) Writing/Verbal Skills __ Use and apply K-2 standards for writing. [Please leave comments if this needs work.] __ Explain the function of nouns, pronouns, verbs, adjectives, and adverbs. (L.3.1.A) __ Form and use regular and irregular plural nouns. (L.3.1.B) __ Use abstract nouns (e.g., childhood). (L.3.1.C)

Student Last Name: ________________________

__ Form and use regular and irregular verbs. (L.3.1.D) __ Form and use the simple (e.g., I walked; I walk; I will walk) verb tenses. (L.3.1.E) __ Ensure subject-verb and pronoun-antecedent agreement. (L.3.1.F) __ Form and correctly use comparative and superlative adjectives and adverbs. (L.3.1.G) __ Use coordinating and subordinating conjunctions. (L.3.1.H) __ Produce simple, compound, and complex sentences. (L.3.1.I) __ Capitalize appropriate words in titles. (L.3.2.A) __ Use commas in addresses. (L.3.2.B) __ Use commas and quotation marks in dialogue. (L.3.2.C) __ Form and use possessives. (L.3.2.D) __ Spell grade-level words and to add suffixes to base words. (L.3.2.E; L.3.2.F) __ Choose words and phrases for effect. (L.3.3.A) __ Recognize differences between the conventions of spoken and written standard English. (L.3.3.B) Part Two: Thinking about the student’s test scores, performance in class, and your observations, please order the categories in order of need for this particular student {1 (most needed)—6 (least needed)} _____ Phonemic Awareness _____ Phonics _____ Fluency _____ Vocabulary _____ Comprehension _____ Writing/Verbal Skills Comments about this student’s reading/writing skill level:

Student Last Name: ________________________

Math Part One: Place a “P” next to specific skills which the student is able to do at a proficient level. Place a “NW” next to skills that would be beneficial for the student to practice. Leave unobserved skills blank. Operations and Algebra __ Use and apply K-2 standards for operations and algebra. [Please leave comments if this needs work.] __ Use multiplication and division within 100 to solve word problems in situations involving equal groups, arrays, and measurement quantities. (3.OA.A.3) __ Determine the unknown whole number in a multiplication or division equation relating three whole numbers. (3.OA.A.4) __ Apply properties of operations as strategies to multiply and divide. (3.OA.B.5) __ Understand division as an unknown-factor multiplication problem. (3.OA.B.6) __ Fluently multiply and divide within 100 (3.OA.C.7) __ Recall from memory all products of two one-digit numbers. (3.OA.C.7) __ Solve two-step word problems using the four operations, variables and estimation strategies. (3.OA.D.8) Base Ten Operations __ Use and apply K-2 standards for base ten operations. [Please leave comments if this needs work.] __ Round whole numbers to the nearest 10 or 100. (3.NBT.A.1) __ Fluently add and subtract within 1000. (3.NBT.A.2) __ Multiply one-digit whole numbers by multiples of 10 in the range 10-90. (3.NBT.A.3) Fraction Operations __ Describe a fraction a/b as the quantity (a) formed when a whole is divided into equal parts (b). (3.NF.A.1) __ Represent a fraction on a number line from 0 to 1. (3.NF.A.2.A; 3.NF.A.2.B) __ Describe two fractions as equivalent if they are the same size, or the same point on a number line. (3.NF.A.3.A) __ Generate simple equivalent fractions, e.g., 1/2 = 2/4, 4/6 = 2/3. (3.NF.A.3.B) __ Express whole numbers as fractions, and recognize fractions that are equivalent to whole numbers. (3.NF.A.3.C) __ Compare two fractions (using symbols >, =, or