The Blosser Center
Student Inquiry Form
The Blosser Center uses the Orton-Gillingham approach, which is phonics-based and multi-sensory. Tutors and students meet at least twice a week for 45-60 minute sessions. These are one-on-one, giving the student the tutor's undivided attention. On average, it takes approximately 2-3 years to complete the sequence and return to grade level.

The Blosser Center for Dyslexia Resources
PO Box 18082, Portland OR  97218
(503) 234-4060 • info@theblossercenter.org
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Your Name
Student Name
Student Gender
Your Relationship to Student
Address
City
State
Zip
Student Race: (Optional)
Student Date of Birth
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Student Age
Student Grade
School
District
Parent 1 Name
Parent 1 Phone
Parent 1 Email
Parent 2 Name
Parent 2 Phone
Parent 2 Email
Referred by
Reasons for Calling/Areas of Concern
Reason Details
Does this student have an IEP?
Please send all IEP and diagnostic testing results to us at info@theblossercenter.org.
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If so, what is the disability on the IEP?
Has there been any neuropsychological, academic, or cognitive testing?
Please send all IEP and diagnostic testing results to us at info@theblossercenter.org.
We require complete diagnostic neuropsychological testing for placement.
This includes cognitive testing (WISC or similar) and usually behavioral assessment (BASC or similar).  If you only have academic evaluations (WIAT, KTEA, CTOPP, etc.) please refer to our recommended testers list to complete your diagnostic testing.
Where was the testing done?
Date of testing (Month/Year)
Please note two or three of your child's interests
Tutoring days and times requested
Tutoring method preferred
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