Parental Consent

The responses you provide in this intake form are confidential, and no personally identifiable data will be shared with anyone outside of our Center for Students with Learning Differences (CSLD) or without your consent. Submitting answers and documentation on this intake form is voluntary. If you do not want to answer a question, you may skip it, but without the information requested it may be more difficult to provide services for your child through the CSLD. We hope you will answer as many questions as completely as you can.

Please type your name and date in the boxes below - these serve as your electronic signature, authorizing us to proceed with taking next steps for your family. Once you have signed this document, please click “Next” to continue onto the intake form. By doing so, you give us your permission to use your responses, documents and data to formulate a plan to serve your student with a disability. Please also note:

The parents of students with a disability will—

Determine whether they, or their student with a disability, or other family members will accept or decline any service from Scholé Academy’s CSLD and its instructors who provide services; and
May decline a service after first accepting it, without jeopardizing other services provided by Scholé Academy in which they also may be enrolled.
Other times when consent is required: There are other times when parental consent may be required when enrolled in intervention services from Scholé Academy’s Tutoring Center.