Austin Dyslexia Reading Center - Every Child Is A Story Yet To Be Told...
 
Contact Us
 
If you would like to contact you for any reason, 
please take a moment to fill out the following form.
 
Thank You!
Penny & Allizon
 
 
Parent's Name
Child's Name
Email Address
Address
Phone
Best time for us to contact you.
Hours
 
 : 
Minutes
 
Age
Current Grade
Current School
Has your child been identified as dyslexic?
Yes
No
Is your child receiving dyslexia services?
Yes
No
Is your child covered under special education?
Yes
No
Is your child protected under Section 504?
Yes
No
Please leave any questions and/or concerns you may have regarding your child.
How did you hear about us?
Accommodations your child is receiving:
Shorted Assignments
Preferential Seating
Extra Time
Not penalized for spelling
Oral responses instead of written responses
Shortened spelling lists
Class notes provided
Small group testing
Test questions read orally
Other
How soon would you like to begin tutoring services?
Would you like us to send you additional information about tutoring?
TUTORING PREFERENCES:
How many days per week do you desire tutoring?
One
Two
Three
What day of the week is tutoring most convenient for your schedule?
Monday
Tuesday
Wednesday
Thursday
Friday
I am flexible with days.
Do you have a preference for a specific dyslexia teacher?
Penny Chilcutt
Allizon Coseriu
Doesn't matter, they are all fabulous & certified!
What time of the day is most ideal for tutoring?
10:00-11:00am
11:00-12:00
12:00-1:00pm
1:00-2:00pm
2:00-3:00pm
3:00-4:00pm
4:00-5:00pm
5:00-6:00pm
6:00-7:00pm
I am flexible with times before noon.
I am flexible between noon to midafternoon times.
I am flexible between 4:00-7:00pm
I am totally flexible with times.
I need additional enrollment information.
Student information form to share with us.
Cancellation policies.
Supply list.
Summer reading camp & registration forms
What type of tutoring do you desire?
Private
Mini-group (2-3 students)
Summer Reading Camp
Summer Tutoring
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