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*Person Completing Form: Student's Name:
*Phone: Student's Current Grade:
*Email: Age:
Please briefly list the primary area(s) that your student is experiencing difficulty:
Reading     Spelling     Writing     Reading Comprehension     Mathematics    
Prior diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) or ADD? YesNo
If YES, describe treatment:
Did this student require any of the following related services?
Speech and/or Language Therapy Yes No          Occupational Therapy Yes No
List any additional special education or remedial services provided to this student in the past:
Is there anything else you would like us to know?
your infomation stays confidential. We don't spam. Ever.
Thank you!
Thank you for your interest in the Prospect Centre. We will be in contact with you as soon as we can.

  • Potential
  • Discovery
  • Outlook

From Orton-Gillingham remedial instruction after-school to home school support, The Prospect Centre assists the learning-challenged student by discovering how he or she learns, then moving forward with solutions that compliment curricula as well as provide a life-long foundation of learning confidence.