RWM APPLICATION

Read/Write & Math Intervention Program Fall 2024 Program Application
Thank you for your interest in our Read/Write & Math Intervention programs. For information on programs, please visit our website by clicking HERE

Please reach out to us at rwmintake@foothillsacademy.org with any questions you may have.

We require documentation supporting any diagnosis. If your child has NOT been diagnosed, please do not check off a diagnosis. You can tell us your concerns for your child in the space provided.

We are offering:

Weekly Literacy (1 or 2 hours per lesson, once a week) Cost: $70/hour

Booster Weeks (Literacy or Math) (2-3 hours per lesson, 4-5 lessons in one week during the school day only) Cost: $65/hour

Intensives (Literacy or Math) (2-3 hours per lesson, 4-5 lesson per week, 4-5 weeks during the school day only) Cost: $65/hour plus mandatory pre- and post-assessment $480

All our programs are 1:1.

All programs have weekly updates.

All programs are with the same instructor barring any unforeseen challenges.

Registration is first come first served. Please indicate ONLY THE TIMES YOU ARE AVAILABLE.

Student Info
Child's Legal Name*

First NameLast Name
Child's Date Of Birth*

MonthDayYear
Parent/Guardian Name*

First NameLast Name
Email*
Phone Number*
Has the student been previously enrolled in any Read/Write Math programs?*

YesNo
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Student Info
Child's Preferred Name
Grade*
School*
Student's first language:*
Spoken at school (majority of classes):*
Spoken at home (most often):*
What diagnoses does the student have? (select all applicable) PLEASE NOTE: If you select a diagnosis, we require documentation supporting that diagnosis before you are given a space in the program. Please upload supporting documentation with this application. Do NOT check a diagnosis if your child does not have a psychoeducational assessment.

ADHDMath Learning DisabilityReading Learning DisabilityWriting Learning DisabilityNo Diagnosed Learning DisabilityOther
Tell us some your child's interests.*
Foothills Academy Society is one of the only programs that offers financial relief to make it easier for students who need support to get the help they need. We rely on fundraising and donations to make this happen. Are you interested in learning about our fundraising efforts?

YesNo
Please identify the top 3 concerns you currently have with your child's literacy skills (your child's instructor will use this information to help create program goals - the more information provided the better):*
I have read the cancellation policy and understand I have to pay a non-refundable deposit of $100 to secure my child's spot when offered a program placement (Initial)

Yes
Are there any potential triggers (fears/phobias/anxieties) or current difficulties in the family (i.e. family member's health, recent death) that may affect your child at our program?*
If your child has applied or completed the intake process for other Foothills Academy programs, please sign below to provide consent to access your child's file. We may access their file to obtain a copy of their psycho-educational assessment or IPP. Programs Include: Psychology Groups, Amicus Camps and Recreation, Foothills Academy School Program

*Please note if your child has completed a psycho-educational assessment through Foothills Academy Community Services, we cannot obtain their assessment without parent completion of a Authorization to Release Information form. Please reach out to rwmintake@foothillsacademy.org if you need to complete this form in order for us to obtain the psych-ed assessment internally.
Sign here to provide consent to access your child's file from the above programs:

Clear
Please upload your child's most recent report card. If not submitted, we will follow up to request this. If your child is a returning student, we already have this information. You may choose to update the report card through Hubshare when you have a new one to share.

Cancelof

Program Selection
The student would attend this course:*
If there is no more availability for your preferred selection, would you accept a spot offered in the alternative facilitation method (i.e. no more available in person spots, would accept online spot)?*

YesNo
Which program would you like to apply for?

LiteracyMathBoth

Which program would you like to apply for?*

Booster (Literacy or Math)Weekly Literacy (No Math)Intensive (Literacy or Math)Small Group Pilot MathMore than one program
Which math program would you like to apply for?

Weekly MathMath Booster

Booster Program

Our 1-week boosters are a more effective option than weekly lessons to fill in specific gaps in literacy skills. Get the same number of hours in one week that you would in 3 months coming once a week. Using the same evidence-based literacy programs, our instructors informally assess your child on the first day of the program and develop literacy goals for the week of the program.

Boosters take place during the school day between 8am-4pm. These are school pull-out programs.

Booster weeks start on Mondays and run either 4 or 5 days (Monday-Thursday or Monday-Friday).

Boosters cost: $700 for 10 hours or $975 for 15 hours

Rolling Intake. Please tell us what Monday you want to start.
How many weeks are you hoping to book?

123
What date do you want to start?

MonthDayYear
Date
Do you prefer 2 or 3 hours per day?

23
Tell us: Literacy or Math?

MATH PILOT PROGRAM

Small group program. 4-5 students in each spot.

Required to attend twice per week.

Students work on foundational skills to support their work in the classroom. Working with an experienced instructor, students will work on math vocabulary, calculation strategies, word problems, and learn foundational strategies like: Chisanbop, Woodin Math, and Visualization.

Limited Spaces available. Candidates will be contacted for additional information.

Program dates September 9-Oct. 9, 2024:

Monday/Wednesday:

Session 1: 4:00-4:50pm

Session 2: 5:00-5:50pm

Session 3: 6:00-6:50pm

Programs are booked in 5 weeks (9 lessons) blocks. No lesson Sept. 30. Cost $405.

Program dates September 10-Oct. 10, 2024

Tuesday/Thursday:

Session 1: 4:00-4:50pm

Session2: 5:00-5:50pm

Session 3: 6:00-6:50pm

Programs are booked in 5 weeks (10 lessons) blocks. Cost per block: $450

Data will be collected as part of the pilot including assessment results, survey feedback, and questionnaires.
The program I am choosing is:
If the program I selected is full I would like to attend this alternate day/time

Literacy Pilot Program

Small Group program.

After school 4:30-5:30 M/W or T/Th

4-5 students in the group with one skilled and certified small group literacy instructor.

Program is booked in 5 week blocks (10 lessons)

COST: $450

As part of the pilot, we are collecting data from assessments, progress monitoring, surveys, and student questionnaires.
Monday/Wednesday or Tuesday/Thursday

Bursary Request
Bursary - I would like to apply for financial assistance for this program through Foothills Academy. (Please note that while the bursary program is not restricted to low income families, an application outlining the need for fee reduction will be sent to you and will require tax documentation).

NoYes
Should be Empty:

Read/Write & Math Intervention Program Fall 2024 Program Application

Student Info

Student Info

Program Selection

Bursary Request