Circles of Love and Peace (CLAP) by Sheila Y. Flemming, Ph.D.

Sheila Y. Flemming, Ph.D.
Founder & President

Circle of Love and Peace (CLAP)

How did you learn about the book club?

Student Name

First Name

Last Name

Age

Gender

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Grade

Personal Address

Address Line 1

City

State

Zip Code

School name

City

State

Parents or Guardians Name

First Name

Last Name

Email

Telephone

Please check all that apply to the student

I read every day

I read sometimes

I read at home

I read to others at home

I am a good student

I have good behavior

I never read at home

My parent(s) require me to read sometimes

I am a good listener

I speak well

I like to write

We have lots of books at home

For more information or details go to www.blackrosefoundation.org or Call (888) 530-9401