MYHID! Afterschool Dyslexia Intervention Enrollment Application 

Are you or someone you know struggling with dyslexia? MYHID, a division of the Speech and Language Institute, is here to help. Our program provides dyslexia intervention for those who exhibit the signs of dyslexia according to the International Dyslexia Association (IDA). 



MYHID! Afterschool program does not admit students of any race, color, nationality, and/or ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students at the school. MYHID Afterschool program does not discriminate on the basis of race, color, nationality, and/or ethnic origin in the administration of its policies and/or programs. 

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Email *
Address *
Phone number (s) *
Martial Status *
Mother's First and Last Name *
Mother's Phone Number  *
Mother's Email *
Mother's Employer and Position *
Mother's Highest Degree and Area of Education *
Mother's Schools Attended *
Father's First and Last Name *
Father's Phone Number  *
Father's Highest Degree & Area of Education *
Father's Schools Attended *
Martial Status *
Required
Complete Address *
Children in Household
ex: 3
*
Applying for Year *
How did you learn about "The Paracletus School"?: *
Do you know any current PCLS families or staff members? *
If yes, please list them here: *
Why do you desire a Classical Christian Education for your child/children? *
What have you learned about PCLS specifically that inspired you to apply? *
Where does your family worship? *
What other programs (schools, online services, co-ops) have been a part of your child's education journey? Please detail below: *
Students Applying for Admission
Name:
Date of Birth:
Current School:
Current Grade Level:

*
Do they have a determined disability? List and date (MM/YY) of disability.  *
Do they have psycho-educational testing within the last 2 years?  If so, from where: *
Students Applying for Admission
Name:
Date of Birth:
Current School:
Current Grade Level:

Do they have a determined disability? List and date (MM/YY) of disability. 
Do they have psycho-educational testing within the last 2 years?  If so, from where:
Students Applying for Admission
Name:
Date of Birth:
Current School:
Current Grade Level:

Do they have a determined disability? List and date (MM/YY) of disability. 
Do they have psycho-educational testing within the last 2 years?  If so, from where:
Students Applying for Admission
Name:
Date of Birth:
Current School:
Current Grade Level:

Do they have a determined disability? List and date (MM/YY) of disability. 
Do they have psycho-educational testing within the last 2 years?  If so, from where:
Students Applying for Admission
Name:
Date of Birth:
Current School:
Current Grade Level:

Do they have a determined disability? List and date (MM/YY) of disability. 
Do they have psycho-educational testing within the last 2 years?  If so, from where:
Students Applying for Admission
Name:
Date of Birth:
Current School:
Current Grade Level:

Do they have a determined disability? List and date (MM/YY) of disability. 
Do they have psycho-educational testing within the last 2 years?  If so, from where:
Describe each applicant’s extracurricular interests and/or achievements:
Additional documentation/information my be requested as a part of the admissions process. 
Type Initials *
Application fee $150.00- Please insert a great phone number to contact for payment *
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