FDLC Tutoring Application Form

Parent Name* This field is required.

First Name

Middle Name

Last Name

Parent Email* This field is required.

example@example.com

Parent Phone* This field is required.

Please enter a valid phone number.

Student Name* This field is required.

First Name

Middle Name

Last Name

Student Grade* This field is required.

Academic Status* This field is required.

Report Card* This field is required.Must show CONDUCT and READING grades for most recent semester.

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Max. file size: 10.0MB

Teacher note of perceived grade level currently reading on or recent testing with estimated reading grade level* This field is required.

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Max. file size: 10.0MB

Psychoeducational Evaluation (if available)

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Max. file size: 10.0MB

Upload Writing Sample OPTIONAL BUT STRONGLY ENCOURAGED Example: dictation sentence Paragraph writing sample (This helps with faster and more accurate group placement)

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Max. file size: 10.0MB

Location Preferred* This field is required.

Willing to Attend an Alternate Location if Needed?* This field is required.

Avondale Location - 2720 Park Street, Jacksonville FL 32205

DePaul School - 9750 Deer Lake Court 32246

Beaches Location - 408 4th St N, Jacksonville Beach, FL 32250

Nocatee Location - 425 Town Plaza Ave, Ponte Vedra Beach, FL 32081

Please Review the Schedule

Select Schedule* This field is required.Enrollment options are Monday/Wednesday OR Tuesday/Thursday

Monday/Wednesday Schedule

Tuesday/Thursday Schedule

Tuition Commitment Clarity* This field is required.If accepted, families must complete enrollment within 24 hours by paying the non-refundable deposit to secure placement.

I understand this is an August–May program commitment.

I understand tuition is paid in three installments for the 64 sessions.

To secure your spot, you simply pay for the first 6 sessions (3 weeks). THIS IS A NON-REFUNDABLE DEPOSIT of $588 that is applied toward tutoring fees. (THIS WILL NOT BE CHARGED UNTIL THE PARENT SIGNS A CONTRACT UPON STUDENT ACCEPTANCE.)

The second installment of $3400 is due by August 1st. The third installment of $2,260 is due December 1st.

Fees charged by merchants to process payments are the responsibility of the consumer.

Students who join later in the year will be pro-rated to $98 per session, at two sessions per week, with the first 6 weeks due at registration.

I understand that when accepted, I will have 24 hours to enroll by paying the NONREFUNDABLE deposit of $588. This will be applied toward the intervention sessions.

I understand there are NO MAKE UP SESSIONS. Missed sessions, for ANY reason, are non-refundable and cannot be rescheduled.

I understand my child will be required to attend a 30-minute in-person screening to ensure they are placed in their most appropriate Orton Gillingham level. This will take place at your tutoring location the last week of July and the first week of August.

I understand group size is typically 4 like-needed students with one interventionist. Each student will work with 1 or 2 Orton Gillingham trained professionals.

I understand my child will be place in a leveled group during ONE of the following time frames, and this is not selectable by the parent. 4:05 - 4:55; 5:05 - 5:55; 6:05 - 6:55; 7:05 - 7:55

I understand programs are contingent on enrollment and may not run if enrollment is not met. ALL FUNDS WILL BE RETURNED IN THAT UNLIKELY INSTANCE.

Signature* This field is required.