Orton-Gillingham Registration Form

To register for a current or previously completed Orton-Gillingham course(s), please complete the form below.

If you have questions, please contact Judie Burridge, Graduate Operations Specialist, at 570-208-5850 or email judieburridge@kings.edu. Thank you.

Date of Birth *

Month

Day

Year

Last Name *

First Name *

Student ID

Student ID for existing King's students.

Address

If you don't know your Student ID, please contact Christine Stevens at christinestevens@kings.edu

Number and Street *

City *

State *

Zip Code *

E-mail Address *

Cell Phone *

Do you receive tuition benefits? *

Yes

Employer Name *

Courses

Term *

Course Number *

EDUC 800 - 23/SP - Orton-Gillingham Initial Course 1

EDUC 801 - 23/SP - Orton-Gillingham Initial Course 2

EDUC 803 - 23/SP - Orton-Gillingham Advanced Course 2

Course Number *

EDUC 800 - 22/FA - Orton-Gillingham Initial 1

EDUC 801 - 22/FA - Orton-Gillingham Initial 2

EDUC 802 - 22/FA - Orton-Gillingham Advanced 1

All student registrants for courses EDUC 800, EDUC 801, EDUC 802 and EDUC 803 must verify that their course(s) meet King's requirement of being International Multisensory Structured Language Education Council (IMSLEC) accredited or being taught by an Academic Language Therapy Association (ALTA) approved Instructor.

Name of IMSLEC/ALTA QI or I-CALP Instructor *

Name of IMSLEC/ALTA QI or I-CALP Training Program *

Location of IMSLEC/ALTA QI or I-CALP Training Program *

Course Start Date *

Month

Day

Year

Completed/estimated end date *

Month

Day

Year

Instructor E-mail *

Instructor 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