request a reading clinic Request a literacy clinic * Contact details for person requesting the clinic First Name Last Name Person/Organization's Email * Phone Number * (###) ### #### What type of community leader are you? * Alderman Block Club Leader Church Leader Community org. Leader Youth Program Director Other What month would you like to host a clinic? * July August September October What is the name of the location where you want the clinic hosted? * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Thank you!
