1.Student Name:

2.Parent Phone Number:

3.Parent Email:

4.What grade is your student in for the 2026-2027 school year?

1

2

3

4

5

6

7

8

5.If you were to GUESS, on which grade level does your student read?

K

1

2

3

4

5 +

6.Which location are you interested in?

Nocatee

Neptune Beach

Tinseltown - DePaul School Location

Avondale

7.If your student has a formal diagnoses of dyslexia or similar, list all that apply (SLD, Developmental Delay, ADHD, etc)

8.Where does your student attend school?

9.Tutoring cost is $88 per hour long session with a group of 4 similar-leveled students with one Orton Gillingham instructor. ALL PROGRAMS are ONE HOUR in the evening between 4:00 PM - 8:00 PM. All programs are a September - May commitment. Which program are you POTENTIALLY interested in. Check all that apply.

3 evenings a week: Mon, Tuesday, Thursday

2 evenings a week: Wednesday, Sunday

HOMESCHOOL ONLY: 5 evenings a week: Mon. Tues, Wed. Thurs. Sun

10.Where did you hear about this opportunity?

11.We will contact you in June with more details and the opportunity to commit to the program. If you have any questions before then, please email, oliveiraa@depaulschool.com

Got it!