Tutoring registration open - contact us todayThank you for your interest in the Hampton Roads Dyslexia Center. Please complete the form below for additional information. Once received, we will be in contact within three business days. Parent/Guardian's Name * First Name Last Name Parent/Guardian's Mailing Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Parent/Guardian's Email * Parent/Guardian's Phone * (###) ### #### Relationship to child * Child's Name * First Name Last Name Child's Date of Birth * MM DD YYYY Child's Current School * Child's Current Grade * My child currently has the following Instructional Interventions * 504 IEP RtI N/A Other If other, please explain What grade level is your child currently reading? * What grade level is your child currently writing? * Please share your child's Pediatrician First Name Last Name Please share any previous or current tutoring services * Please share any previous testing for Dyslexia * Are you able to email copies of previous testing? Yes No Not sure What type of information are you seeking? * Tutoring Services Screening, Assessment & Testing Advocacy Other If other, please explain Tutoring site preference Newport News Yorktown Williamsburg Chesapeake/Western Branch Chesapeake/Greenbrier First Available Virtual *not applicable for all students How did you hear about us? * Thank you!
