Application for Psychoeducational Assessment Funding
If you need assistance filling out this form, please email Sarah at sarah@glowingheartscharity.org or leave a voicemail at 249-888-6695 and Sarah will be in touch within a few days (email is preferred).

IMPORTANT
  • To be eligible for funding your child must be in grade 2, 3, 4, or 5 and living in Simcoe County.
  • You will be asked to submit scans/photos of the most recent Income Tax Notice of Assessment for all family members over the age of 18 (living in the household) in this form. If you need help with this, you'll find instructions on the webpage, or you can reach out to Sarah.
  • Prior to being approved for this program you may be contacted to submit further information/documentation about your child's learning needs.
THOSE WHO ARE APPROVED WILL BE CONNECTED WITH A PSYCHOLOGIST TO COMPLETE THE ASSESSMENT.

You will receive a confirmation email immediately after submitting.
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Email *
Parent/Guardian First Name *
Parent/Guardian Last Name *
Phone *
Full Mailing Address  *
First & Last Name of Child Requiring the Assessment *
Child's School *
Child's Current Grade *
Child's Birthdate *
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/
DD
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Does your child self-identify as Indigenous? *
Does your child self-identify as Black or other racialized person? *
Does your child have an Autism Spectrum Disorder diagnosis? If yes, please explain. *
Have you been told that your child might have Autism Spectrum Disorder? If yes, please explain. *
Has your child had a previous psychoeducational assessment? *
If you answer yes to the previous question, please provide details and date completed.
Has your child had a vision assessment within the last 2 years? *
Has your child had a hearing assessment? *
What is the custody situation with the child? Please note that at this time Glowing Hearts Charity is unable to accept families with unresolved custody arrangements. We welcome your application once custody has been determined. *
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