Dyslexia Compass Registration

Family Support Intake Form
Full Name*

First NameLast Name
Email*
example@example.com
Phone Number
Format: (000) 000-0000.
City/Town
Province or Territory*
What is your preferred method of communication with the support team? (check all that apply)*

EmailPhoneZoom
I have questions about how to support:*

My child (select this if you are the parent, family member, or guardian)MyselfMy student (select this if you are an educator, tutor, or teacher)My patient/client (select this if you are a medical doctor, psychologist, or social worker)A person with dyslexia (not myself)Other
In what school board is the child/student registered?*
Please type the full name of the school board
What type of school is your child enrolled in? (check all that apply)*

EnglishFrench ImmersionFrancophonePrivate School
What questions do you have for the Dyslexia Compass team? Please provide information such as child's age, grade and any supports/interventions currently in place.*
If you live in the Winnipeg area, would you like more information about our in-person family support group?

Yes I am interested in periodically meeting with other familiesNot interested at this time
Are you planning on returning to post-secondary education (tech school, college or university)?*

YesNo
Do you need information about accommodations for your workplace?*

YesNo
What questions do you have for the Dyslexia Compass team? Please be as specific as possible.*
Which of the following would you like more information about? (check all that apply)*

General information about dyslexiaHow to obtain an assessmentThe Independent Education Plan (IEP) processTutoringEmotional supportTechnologyReading materials or resourcesFinancial supportsPost-secondary accommodationsOther
Based on the information provided we will match you with a specific volunteer who can best provide support your family's needs. Typically we will respond within 3 business days. During busier times we may take a little longer.

If your question is urgent please email info@dyslexiacanada.org for faster response.
If you would like to be added to our mailing list, please check off which emails you would like to receive.*

Family Support program emailsDyslexia Canada monthly newsletterI don't want to subscribe to any emails at this time
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Family Support Intake Form