Request edit access
Illuminations: Summer 2023
Please let us know if you are interested in summer services with Illuminations. Please answer all questions, if something does not apply please answer "N/A". Summer semester will run from June 5 -29 and July 5-27.

All services at Illuminations Center for Dyslexia are provided on a Sliding Scale basis. This Sliding Scale is based upon the Federal Poverty Guidelines. If your family earns below 200% of the federal poverty guidelines, your family will pay a percentage of the fees for therapy, tutoring, and reading comprehension. Please note the posted fees are guidelines and may be adjusted based on your income, expenses, and ability to pay. All services provided at Illuminations Center for Dyslexia are $50 per hour. A continuance of Sliding Scale benefits is not guaranteed and is subject to modification and/or elimination at the sole discretion of Illuminations Center for Dyslexia. 

Sign in to Google to save your progress. Learn more
Email *
Are you interested in Summer Services? *
Student Name *
age *
School *
Grade *
Parent(s) Name *
Mailing Address (include city, state, zip) *
Phone Number *
Best Contact Times *
Is your child able to recognize words at a glance? *
Is he/she able to tell what happened in a story read aloud? *
Does your child have difficulty with math? *
What are your main concerns? *
Does your child receive dyslexia therapy currently? *
Does your child have any of the following? *
If diagnosed, when and where was testing completed? *
Preferred Method of Summer Services *
Time of Day for summer services *
Days of the Week?
How many sessions per week will you be able to attend? Are there any challenges to getting your child to the center? Other considerations for scheduling? *
Days when your child when not be able to come in due to pre-planned vacations or events? *
Have you completed your application for the sliding scale? *
Clear form
Never submit passwords through Google Forms.
This form was created inside of Illuminations Center for Dyslexia. Report Abuse