RWM APPLICATION - Winter 2026

Parent Information
Parent/Guardian Name*

First NameLast Name
Email*
Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Are you interested in registering for a Parent Training Program?*

Yes, SIGN ME UP!No
Select your preferred Parent Training Program time:*

Student Information
Student Legal Name*

First NameLast Name
Student Date Of Birth*

MonthDayYear
School*
Grade*
Read/Write & Math Intervention requires submission of the most recent report card. Please upload here. *

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Student Primary Language:*
If English is not your child's primary language, please provide details about their current level of English proficiency.
Has your child previously enrolled in Read/Write & Math Intervention programs?*

YesNo
Does your child have any diagnoses (e.g., ADHD, learning disability, or other)?*

YesNo
Please specify your child's diagnosis (select all that apply):*

ADHDReading Learning DisabilityWriting Learning DisabilityMath Learning DisabilityOther Diagnosis

Student Learning Profile
Read/Write & Math Intervention requires documentation supporting any diagnosis. All applications for students with a diagnosis must include submission of a psychoeducational assessment. Please upload here. *

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Student Learning Profile
Read/Write & Math Intervention programs provide structured, remedial and intervention-based programming. Please identify the concerns you have with your child's literacy and/or numeracy skills. *

Program Selection
Which program would you like to apply for?*

Intensive ProgramBooster ProgramWeekly ProgramFoundations in Math: Small Group Program

Multiple Programs - Foundations in Math: Small Group Program
Small group math programs require attendance twice per week and a minimum of 2 students enrolled in the program to run. Select the program you are interested in:*

January 5 - February 5February 9 - March 16SIGN ME UP for both sessions
I am interested in attending:*

Monday & WednesdayTuesday & ThursdaySIGN ME UP for either option
Monday & Wednesday Program Times:*
Tuesday & Thursday Program Times:*

Terms & Acknowledgements
Foothills Academy Society 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 more about our fundraising efforts?*

YesNo
Financial assistance is available through Foothills Academy. Please note that the bursary program is not restricted to low income families; however, an application outlining the need for fee reduction will be sent to you and will require tax documentation. Would you like to apply for bursary?*

YesNo
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Read/Write & Math Intervention