Hope Academy for Dyslexia Inquiry Form
Parent/Guardian Information
Parent Name
*
Cell Phone
*
Parent email address
*
How Did You Hear About Us?
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Online
Social Media
Current Family
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Dianostician
Drove by the school
Other
How did you hear about our school?
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Before 10:00 AM
Between 10:00 AM and 2:00 PM
After 2:00 PM
Tuesday
Wednesday
Thursday
Friday
What are your student’s primary learning differences?
*
Would you like to attend our School Open House Tuesday, February 24, 2026, at 6:30 PM?
*
Yes
Not at this time
Request a private tour
Would you like to request a Private Tour?
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Yes
No
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Student Information
Student Name:
*
Grade Level of Interest
*
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1st
2nd
3rd
4th
5th
6th
Has your student been diagnosed with dyslexia?
*
Yes
No
If yes, when was this diagnosis made?
Please submit the student's Diagnostic Evaluation if available.
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Has your child previously received therapy for dyslexia?
*
Yes
No
If so, where?
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