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 •
Your Name
Student Name
Student Gender
Your Relationship to Student
Student Date of Birth
Student Age
Student Grade
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
Clear selection
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
Where was the testing done?
Date of testing (Month/Year)
Tutoring days and times requested
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