RISE (Orton Gillingham) Program Application Form

Application for RISE (Orton Gillingham Reading) Program

To apply for this LDAO-C program please fully complete form below. This information will be kept strictly confidential, and will only be shared with our staff and program facilitators/volunteers.
RISE is our in-house scientifically backed Orton Gillingham Reading Program. Orton Gillingham is the gold standard for remediation reading disabilities. Our program is multi-sensory and rule based and builds on skills to help children learn to decode and blend. It also focuses on common spelling rules, taught in an approved OG method. The program also adds in fun reading games and online activities.

Although a few weeks will not close the reading gap and bring children to grade level, it will provide the basic skills needed to tackle reading and understand some of the spelling rules.

Students will be matched with a trained tutor and meet for individual tutoring once or twice a week for a total of 10 sessions. Sessions are 60 minutes in length and take place either in person at our location or online.

Dates and Times: various, to be arranged between tutor and student

Location: In-person at our new LDAO-C Learning Centre (1547 Merivale Road, Suite 450) or online, to be arranged between tutor and student

Skill Development and Practice Areas: phonological awareness, phonics, fluency, vocabulary, comprehension

Cost: $500.00

Email bailey@ldaottawa.com for more info
Parent/Guardian Contact and Membership Information
Please indicate your relationship to the child:*

MotherFatherGuardianOther
Your Name*

First NameLast Name
Your email address*
example@example.com
Phone Number. (Please provide the number we could reach you at in the hours before and during program times) **
Address*

Street Address

Street Address Line 2

CityProvince

Postal Code
Are you a member with the LDAO-C?*

I am a current LDAO-C member.I am not an LDAO-C member.I am not sure whether I am an LDAO-C member. Please check for me.
Service Delivery
Are you applying for in-person (LDAO-C Learning Centre) or online tutoring services?*

In-Person (LDAO-C Learning Centre)Online (Zoom)
As you have selected online tutoring services, who is available during the online session to support if needed?*

MotherFatherOther
Does your child have access to reliable high-speed internet, a computer/laptop with built-in speakers, a microphone and webcam to support the online tutoring session?*

YesNo
Child Information
Child's First and Last Name*

First NameLast Name
Child's Age*
In which school board is your child's school?*

Ottawa-Carleton District School BoardOttawa Catholic School BoardConseil des écoles publiques de l'Est de l'OntarioOther
Has your child been referred to this program by their school? **

YesNo
What is the name of your child's school?
Child's Expected School Grade for the School Year*
Student Profile

Please provide as much detailed information as possible to assist with screening.
If your child has a formal diagnosis of a Learning Disability, please list, including who made the diagnosis and when. **
If your child has been diagnosed with other exceptionalities (i.e. ADHD, OCD, Autism, Intellectual Disability), please list, including who made the diagnosis and when **
Specify what areas your child struggles with because of their Learning Disability/difficulty (i.e. Reading difficulties, Memory, Math, Social Skills, etc.)? (even if they don't have a specific diagnosis) **
What are your child's strengths in relation to their social skills? *
Are there any medical or behavioral issues that we need to be aware of? Please specify **
Does your child have any special interests, abilities, hobbies, sports?*
Is there any additional information you would like us to know about your child?*
Academic Level

MUST provide grade level of performance; if unsure ask child's teacher
Reading:*
Spelling:*
Writing:*
Math:*
Is your child currently on an IEP? **

YesNo
Student's Current School Placement:*

Regular ClassRegular Class with Withdrawal SupportSelf-Contained Class
Availability and Frequency
Please share your availability for sessions; this will help us match your student up faster (ex, weeknights, weekends, specific times). If you desire multiple sessions a week please also note this here.
Waivers and Conditions of Enrollment in RISE (Orton Gillingham Reading) Program:
1. The parent or guardian of the above-named participant, releases LDAOttawa, its directors, staff, agents and members from any loss, personal injury, accident, misfortune or damage to the above-named or his/her property, with the understanding that reasonable precautions shall be taken to ensure the health and safety of the above-named participant.

2. For the program to be effective and out of respect for the tutors we ask families to commit to attending each session of the program they register for and all scheduled sessions. If you will be unable to attend a session, you must inform the program tutor within 24 hours of the scheduled session or the session may be forfeited depending upon the circumstance.

3 For the program to be effective and out of respect for the tutors we ask families to commit to attending all 10 sessions within a 16 week time frame; unless otherwise discussed with the Center Director.

4. For the safety of the staff and other participants, LDAOttawa has the right and responsibility to take actions such as notifying the parent or guardian of issues as well as possible dismissal from the program if a child exhibits continual inappropriate behaviour.
I I have read and hereby accept the above waivers and conditions of enrolment and give the LDAOttawa permission to share my child’s information with the appropriate staff and tutors.I have read and hereby accept the above statements of attending and completing all 10 sessions in a timely manner of 16 weeks, unless other arrangements have already been made with the Center Director.
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Application for RISE (Orton Gillingham Reading) Program

Parent/Guardian Contact and Membership Information

Service Delivery

Child Information

Student Profile

Academic Level

Availability and Frequency

Waivers and Conditions of Enrollment in RISE (Orton Gillingham Reading) Program: