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Reading Certification Program Application
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Name
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Your answer
Email
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Your answer
Phone number
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Your answer
Address
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Your answer
Date of Birth
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Your answer
Do you have teaching experience, or experience with people with dyslexia, ADD or other processing issues?
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Yes
No
Have you ever been convicted of a crime? If so, please explain.
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Your answer
Have you ever been convicted of a crime against a child? If so, please explain.
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Your answer
Do you have a bachelor's degree in any field?
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Yes
No
Do you enjoy working 1:1 with children?
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Yes
No
Do you enjoy sustained, complex reasoning tasks?
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Yes
No
Do you have strong communication skills?
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Yes
No
Do you have a deep well of patience, empathy and understanding within you?
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Yes
No
Please share the reasons why you are interested in this program.
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Your answer
Anything(s) that would prevent you in participating in this program?
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Your answer
What questions do you have about the program?
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Your answer
What would you like to gain from the program?
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Your answer
Please share any additional concerns.
Your answer
What is the best method and hours to contact you?
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Your answer
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