Tutor Referral Application

Everyone Reading Illinois frequently receives calls and emails from parents and adults with dyslexia looking for referrals for tutors and diagnosticians. If you are a teacher, tutor, or therapist specially trained in using a multi-modal, structured literacy approach, we would love to add your name to our Referral List! All applications must be approved by our Board of Directors.

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Contact Information

First Name

Last Name

Phone

Country

Address Line 1

Address Line 2

City

State

ZIP Code

Membership

Helps our staff understand your affiliations. Not shown in the public directory.

Are you an ERI member?

Yes

May we list your contact information in our referral directory?

Yes

Employer / School

Other professional memberships

International Dyslexia Association (IDA)

Learning Disabilities Association (LDA)

CHADD

Other

If other, please specify

Subjects & Grade Levels

Tutoring Location & Availability

How do you tutor?

Where are you willing to tutor?

Cities, neighborhoods, or areas you serve. Shown in the public directory.

Times

Days and times you are generally available.

Are you willing to tutor outside your home or office?

Yes

Structured Literacy Training

List the structured literacy training you have completed.

Training

Supporting Documents

Resume and certificates

PDF, JPG, PNG, DOC or DOCX, up to 5MB each.

Education

Certifications

Certification

References

Please provide at least one professional reference.

Reference

Reference 1

Full Name

Relationship

Company or School

Phone

Attestation

I certify that my answers are true and complete to the best of my knowledge. I am attesting to my statement of all credentials, education, degrees and licenses and that I have not been convicted of any felonies or crimes. If this application leads to approval, I understand that false or misleading information in my application may result in my name removal from the referral list. I also understand that my signature provides permission for a member of the committee to call my listed references and also it is an indication that the committee may ask the applicant to provide written letters for reference. Respond time from Everyone Reading Illinois in regards to decision, is usually within one month from the receipt of the completed application in the office.

Signature

By typing your full name below, you agree to the terms and conditions of this agreement.