Structured Multisensory Language Foundations Training Application

Structured Multisensory Language Foundations Training Application

Apply to join our comprehensive training program in multisensory language instruction.
Full Name

First NameLast Name
Date of Birth

MonthDayYear
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Personal Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

Educational and Professional Background
Undergraduate (Degree, Institution, Year)*
Graduate (Degree, Institution, Year)
Please list all additional certification(s) and trainings you have received in Structured Language

Current Professional Information
Employer (Name of School)
Supervisor and Title (ex. Jan Smith, Principal)
Work Phone (xxx-xxx-xxxx)
Work Email
Is your supervisor aware of your application?
Current Occupation/Role (Ex. 3rd Grade Teacher)
Will you be continuing in the same position next year? If not, please choose "Other" and explain what position will you have.

Other

Your Role as an Academic Therapist
Do you plan to implement this curriculum as part of your regular school day? If not, please choose 'other' and explain.
Who will determine your schedule?
Tell us more about your expected student group composition. What types of students do you expect to be teaching the SMLF curriculum to? (ex. Students who have IEPs for Specific Learning Disabilities in Reading, minutes per day, times per week, groups per week)
Why are you interested in this training?
How do you intend to utilize the skills of an Academic Language Therapist?
To date, what experience have you had with dyslexia? Consider educational, professional, and personal experiences in your answer.
What services are provided by your school, school district, or community to meet the needs of students with dyslexia?
Which K-3 screening instrument/formative assessment for reading is used in your district?
Who administers these assessments?
Who will be referring students to you to receive reading therapy services?

Acknowledgement of Phone or In-Person Interview
I acknowledge that this is a post master's degree course that requires a background in teaching and teaching reading, phonics, language arts, or other related areas. I also understand that a phone or in-person interview may be part of the application process.

Acknowledgment of Two-Year Commitment
I acknowledge that as part of a nationally certified program I am responsible for fulfilling all of my practicum hours in year one and year two. I understand that if I do not fulfill my practicum and seminar hours in year one, I cannot move onto year two. Furthermore, I understand that it is my responsibility to find students to work with and I will make a commitment to work diligently to fulfill all required practicum and seminar hours.

Acknowledgment of Practicum Hours and Group Requirements
I understand that as a nationally accredited program I must work with a minimum of 3 groups (a group can be one child) and I must teach a minimum of 2 lessons per week to ensure I have taught up to lesson 35, completion of curriculum book 2, to move on to the advanced (2nd) year.
I acknowledge that this program is a two-year nationally certified program and that I am committed for two years. I also acknowledge that IF I do not meet all of the requirements to move on to the advanced (2nd) year, I am required to pay a re-enrollment fee of $1000 and repeat the Intro course (1st year).
I understand that as a nationally accredited program I must attend ALL scheduled seminars. No absences (other than extreme life-altering situations) will be allowed. In addition, I understand that I am responsible to communicate to both Crossroads Learning Center and my instructors any pertinent information that will affect my completion of the certification program (absences, name changes, contact information changes, job change, life altering situations, etc.)
I understand that there are deadlines throughout this course that MUST be met. I further understand that if my assignments, both textbook and demonstration lesson assignments are not met, I may be required to repeat a year.

Acknowledgment of Requirements and Policies
I acknowledge that I have read and understand the training requirements, as presented in the "Structured Multisensory Language Foundations Objectives and Requirements" document, and agree to comply with such requirements and practices as a condition of my participation in this training.

I acknowledge that the total cost for the 2 years of training, including all materials and books is $6100. I agree to pay a deposit of $1000 no later than May 15, 2026, and the remaining balance of $5100 due by November 1, 2026.
Required Documentation

Please Upload the following documents.
*College Transcript

*Current Teaching Certificate

*Three (3) Letters of Recommendation
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Educational and Professional Background