StandUpU Application Form
Thank you for your interest in StandUpU! StandUpU is an exciting series of 3 workshops designed for students 6-10 years of age with dyslexia, ADHD, and other related learning differences. I understand that if my child is accepted into this program that they will need to attend all three workshops. Completion of the form does not guarantee acceptance into the StandUpU program.

If accepted into the program you agree to pay the $50 supply fee, to help contribute towards expenses.
Email address *
Parents Name
Your answer
Parents Phone
Your answer
I am interested in Volunteering. (check all the apply)
Student Name
Your answer
Student Age
Your answer
Student Grade
Your answer
School Your Child Attends
Your answer
Has your child attended a StandUpLD workshop in the past?
What Learning Differences has your child been diagnosed with?
Your answer
Have you talked with your child about their Learning Difference?
How does your child's LD impact them at school and at home?
Your answer
How would you rate your child's self-esteem?
Low
High
How would you rate your child's ability to self-advocate at school?
Never
Yes and with confidence
Can your child talk about their learning disability?
Not a all
Yes with Pride
How does your child feel about their learning disability?
Your answer
How do you think your child will interact with others in a workshop setting?
Your answer
Describe your child's personality?
Your answer
Is there anything else we should know about your child?
Your answer
Does your child take medication that he or she will need to take during our workshops?
Does your child have any food allergies or medical conditions we need to know about?
Your answer
Do you require a scholarship for the $50 supply fee?
By submitting this form and if accepted into the program, I am committed to bringing my child to all 3 of the workshops and paying the $50 supply fee. The workshops are currently scheduled for: Saturday 2/8/2020, Saturday 2/29/2020, Saturday 3/28/2020. All workshops will start at 3:00 pm and end at approximately 5:30 pm on those Saturdays.
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