Application for Academic Summer Program
Thank you for your interest in LDA Minnesota's academic summer program! Please answer the following questions to give us some more information about your needs.

If you have any documentation to share with LDA prior to starting services (such as an IEP, 504 Plan, other accommodation plan, etc.) please email it to kn@ldaminnesota.org, fax it to 952-582-6031, or mail it to 6100 Golden Valley Rd, Golden Valley, MN 55422.

Please call us at 952-582-6000 with any questions.

Email address *
Student's Name *
Your answer
Application Date *
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Student's Date of Birth *
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Student's Gender *
Student's Age *
Your answer
Student's Grade
Your answer
Parent/Guardian Name *
Your answer
Current Street Address *
Your answer
City, State, and Zip *
Your answer
Preferred Phone Number *
Your answer
Preferred Method of Contact *
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