Dyslexia Evaluation Services

This form will notify us of your interest in receiving a professional dyslexia evaluation led by a licensed Speech Language Pathologist (SLP) from the INW Dyslexia Alliance.
You do NOT need a referral to seek a dyslexia evaluation through us.

Please review before moving forward:
We suggest a donation between $900-$1,100 for an evaluation to cover operating costs and contribute to the Client Assistance Fund. Consider the following when determining your pledge:

A donation of $700 covers the cost of running an evaluation. This is a tax-deductible donation (other providers may charge cash pay clients $2,300+ for a similar service).
If this pledge amount feels challenging, you might consider inviting friends and family to contribute to the CAF on your behalf.
Anything pledged over $700 goes into our Client Assistance Fund to help other families in our community who are seeking similar services but are experiencing financial challenges.

We encourage you to review our recommended provider page to determine whether the Alliance is the best fit for you based on your insurance coverage, timeframe, and financial needs.

Name of person completing this form

First Name

Last Name

Phone

(###)

###

####

Age of person seeking dyslexia evaluation

Clients must be between the age of 6-18 (please submit multiple forms if you have multiple clients)

Concerns

Current School

School District

Referred by (if applicable)

How did you hear about us?

Donation

Our "donate what you can" model supports families of all income levels. We suggest a donation between $900-$1,100 for an evaluation. This covers the operating costs and pays back into the Client Assistance Fund. Please keep in mind the following when determining your pledge: - $700 covers the cost of running an evaluation. - Anything pledged over that amount goes in our Client Assistance Fund to help other families in our community who are seeking a similar service, yet are experiencing financial challenges. - This is a tax-deductible donation. - Other providers typically charge cash pay clients $2,300+ for a similar service. If you are not in a position to give the suggested donation, we ask you give what you can. The Client Assistance Fund (CAF) - built up by donors, grantees and fundraisers - is an instrumental part of providing financial assistance to families. Suggested donations towards evaluations are reviewed by our Board of Directors and approved based on the balance in our CAF. Donations can be made via cash, check, debit or credit card. You will receive a donation receipt for the full amount pledged.

Donation Amount

$700 covers the cost of running an evaluation. Any extra funds are directed back into the CAF, assisting other families seeking a similar service but dealing with financial challenges. If this pledge amount feels challenging, you might also consider inviting friends and family to contribute to the CAF on your behalf.

$1,100

$1,000

$900

$800

$700

Other Amount (please note below)

Other Amount

Put N/A if Donation Amount already selected above

The INW Dyslexia Alliance only evaluates for dyslexia. If additional concerns are present, clinicians may suggest additional and separate testing. However, it is the responsibility of the caregiver to address on their own accord.

I understand this evaluation will only be for dyslexia

Please confirm by checking box

I understand the INW Dyslexia Alliance does not accept insurance

Please confirm by checking box

We’re always accepting donations…

When you give to the INW Dyslexia Alliance, you are making an investment in the life of a struggling reader. Your gift, no matter the size, not only positively impacts a student’s educational journey, but helps them thrive in all areas of life!

Help us continue our efforts and change more lives by making a tax-deductible gift today.

Donate

Dyslexia Evaluation Services

We’re always accepting donations…

Welcome! We’re glad you found us!