Thank You for Your Interest in Our Comprehensive Foundational Literacy Skills Assessment, Parent Conference and Optional Written Report.

This two-hour assessment will identify and detail your child's specific literacy skill strengths and deficits.

Assessment Plus Parent Conference: $300 USD

Optional Comprehensive Written Report: +$300 USD

Please complete the form below to apply for a private assessment.

Parent/ Guardian Information

First Name

Last Name

Phone *

Email *

Address

Street Address

City

State

Country

Enter your country

Postal Code

Student Information

Student's Full Name

Student's Date of Birth

Students grade level

What is your child's current reading level?

Is your child homeschooled?

If yes, please provide details about your child's homeschool program:

Educational Background

What are your primary concerns regarding your child's literacy development? Choose all that apply.

Reading Accuracy

Reading Fluency

Reading Comprehension

Spelling

Writing

Phonics

Dyslexia Concerns

Attention and Focus

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Other:

Has your child previously received educational intervention or tutoring?:

If yes, please describe (Response optional):

Has your child previously completed an educational, psychoeducational, or literacy assessment?:

If yes, please provide details (Response optional):

Has your child received a professional diagnosis?:

If yes, please select all that apply (Response optional):

Dyslexia

ADHD

Speech or Language Disorder

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Please provide additional details (Response optional):

Parent Input

What are your goals for this assessment?

What specific concerns would you like addressed during the assessment?

Is there any additional information you would like the assessor to know about your child?

How Did You Hear About Us?

YouTube

Facebook

Instagram

Google

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I certify that I have full legal authority to enroll the child(ren) in this program. I acknowledge that I have read and agree to the Dyslexia Rescue Terms of Use and Privacy Policy. I also consent to receive communications from Dyslexia Rescue regarding this application and related services.