StandUpLD Student Event Application Form
Thank you for your interest in StandUpLD!  Our StandUp & LIVE LOUD event is designed for students 8-12 years of age with dyslexia, dyscalculia, ADHD, and other related learning differences. 

This event is on Sunday, April 2, 2023 @ 2:30 - 3:30 pm at the Fort Worth Museum of Science & History. Students will be able to visit other museum exhibits before or after our workshop with their parents.  

I understand that if my child is accepted into this program that they will be expected to attend the upcoming workshop. Completion of the form does not guarantee acceptance into our StandUpLD program. 

If accepted into the program you agree to pay the $30 supply fee & entrance to the museum per child, to help contribute towards StandUpLD's non-profit expenses.
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Email *
Parents Name
Parents Phone
I am interested in Volunteering. I understand that I will need to go through a background check.
Students First and Last Name
Student Age
Student Grade
Name of the School Your Child Attends, & City
Has your child attended a StandUpLD workshop in the past?
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What Learning Differences has your child been diagnosed with?
Have you talked with your child about their Learning Difference?
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How does your child's LD impact them at school and at home?
How would you rate your child's self-esteem?
Low
High
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How would you rate your child's ability to self-advocate at school?
Never
Yes and with confidence
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Can your child talk about their learning difference?
Not a all
Yes with Pride
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How does your child feel about their learning difference?
How do you think your child will interact with others in a workshop setting? Do they do well in a larger group? If not, what does your child need to feel comfortable in a group setting?
Describe your child's personality? Is your child outgoing, social, shy, or keeps to themselves?
Is there anything else we should know about your child?
Does your child take medication at school to help with attention? If so, do you plan to give them their medication for this workshop? 
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Does your child have any food allergies or medical conditions we need to know about?
Do you require a scholarship for the $30 supply fee?
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By submitting this form and if accepted into the program, I am committed to bringing my child to the workshop on Sunday, April 2, 2023 at 2:30 pm and paying the $30 supply fee. Space is limited.
I give StandUpLD permission to use photos or videos taken at our StandUpLD events for promotional purposes. 
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