Email Address

Age & Date of Birth

Which school year are you applying for?

Student's Current Grade

Student's Current Educational Status

School, hours attending, level of support being provided, level of support needed to be successful, student's IEP goals, etc.

Does the student have any formal diagnosis that might affect their learning?

e.g., ASD, Down Syndrome, ADHD, Intellectual Disability, Childhood Apraxia of Speech, Dyslexia, Dyscalculia, etc.

Please describe the student's current communication style, including main mode of communication.

e.g., 'uses Picture Exchange Communication System (PECS) to communicate wants and needs; uses verbal speech with 2-3 word phrases, can communicate fluently with full sentences but requires visuals to support understanding as a listener, etc.

Please briefly describe any past/current services.

e.g., OT, SLP, PT, Counselling, Supported Child Development, Behaviour Consultation, Behaviour Intervention, Psychiatry, Tutoring, etc. and please indicate where these supports are being provided (e.g., at school, privately at home, etc.)

What are your long-term goals for the Student? Short-term? If applicable, what are the student's personal goals?

e.g., I would be happy to see my child communicate wants/needs; we desperately want our child to learn to read; our biggest goal for our child is that they feel safe and welcomed at school; we need for our child to be comfortable with entering new community locations like the grocery store, etc.

Please describe any strategies/supports that have been beneficial for the student in the past.

What has worked well for them? What do they need to succeed?

Please describe any strategies/supports that have not worked for the student in the past, or have not been sufficient in other learning environments.

If this is something you are hoping to find in our Education Program, please be explicit about what your child needs so we are able to determine if this is something we can provide.

Please share any additional information about the learner that you think would be helpful to share.

e.g., medications the student is on, any family dynamics that are relevant to the student's learning, if you are hoping to work with a specific Distributed Learning school, etc.

What questions do you have about our Education Program?

We will reach out to schedule a meeting with you to discuss if we might be a good fit for the student. Please be sure to indicate any questions here so we can address them in our meeting!

Education Program Application