Orton-Gillingham Registration Form

To register for an current or previously completed Orton-Gillingham course(s), please complete the form below. If you do not know your Student ID number, please email judithburridge@kings.edu.

If you have questions about the program or would like to sign up as a new student, please contact Christine Stevens, Director of Graduate Admission, at 570-208-5991 or christinestevens@kings.edu. Thank you.

Date of Birth *

Month

Day

Year

Last Name *

First Name *

Student ID *

Address

Number and Street *

City *

State *

Zip Code *

E-mail Address *

Cell Phone *

Do you receive tuition benefits? *

Yes

Employer Name *

Course 1

Term *

Course Number *

All student registrants for courses 800, 801, 802 and 803 must verify current or previous enrollment in an IMSLEC accredited course.

Name of IMSLEC Course Director/Instructor *

Course Start Date *

Month

Day

Year

Completed/estimated end date *

Month

Day

Year

E-mail *

Phone number *

If you have any questions or comments, please enter below

Note: Discontinuation of class attendance or notice to an instructor does not constitute authorized withdrawal. If you stop attending class and do not notify the Registrar’s Office, you will receive a grade of “F” and be liable for all tuition charges.

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Orton-Gillingham Registration Form