Application Instructions

Step 1: Complete and submit the online Program Application Form. If you require this form to be provided in an alternate format, or if you require assistance completing this form, please contact us at info@LDANiagara.org or (905) 641-1021 and we will be happy to accommodate.

Step 2: Submit supporting documentation (proof of a diagnosed, identified or suspected learning disability). Supporting documentation may include:

Most recent report card OR progress report (*required, unless otherwise arranged with the Program Coordinator);
Individual Education Plan (*required, if applicable);
Assessments (if applicable);
Teacher Feedback Form (if possible – Click Here for the Teacher Feedback Form);
Any additional information that you feel may be useful in determining the applicant’s needs for the program.

Supporting documentation can be uploaded to the Program Application Form, or emailed to the appropriate Program Coordinator. Other forms of documentation may be accepted in lieu of a report card/progress report with prior approval from the Program Coordinator. For questions regarding acceptable documentation, please contact us at info@LDANiagara.org or (905) 641-1021.

Once received, applications will be screened for eligibility. LDANR programs are designed for individuals with learning disabilities, not other exceptionalities. If unsure of eligibility, contact the office prior to completing the form at info@LDANiagara.org. Following screening, applicants will be notified closer to the program start date regarding the status of their application.

Important Notes:

The application is NOT CONSIDERED COMPLETE until the applicant’s most recent report card/progress report has been received (unless other documentation is arranged with the Program Coordinator).
When completing the application form, it is suggested that you have a copy of the applicant’s report card handy.
Be sure to click ‘Submit’ when you have completed the Program Application Form.
You cannot save the Program Application Form.

Step 1 of 7

Please note, the LDANR's primary form of communication is through email.
Primary Contact Name*
The Primary Contact is the person who will receive communication about the program from LDANR staff.
Title First Name Last Name
Primary Contact Email*
Primary Contact Phone Number*
Address*
Street Address City Postal Code
Municipality*
If you are unsure which Niagara municipality you are located in, please refer to the section below.
Please Specify:*
Municipality of Fort Erie: Cities include Crystal Beach, Fort Erie, Ridgeway, Stevensville

Municipality of Grimsby: Cities include Grimsby

Municipality of Lincoln: Cities include Beamsville, Campden, Jordan Station, Vineland, Vineland Station

Municipality of Niagara Falls: Cities include Niagara Falls

Municipality of Niagara on the Lake: Cities include Niagara on the Lake, Queenston, St. Davids, Virgil

Municipality of Pelham: Cities include Fenwick, Fonthill, Ridgeville

Municipality of Port Colborne: Cities include Port Colborne, Sherkston

Municipality of St Catharines: Cities include St Catharines

Municipality of Thorold: Cities include Allanburg, Port Robinson, Thorold

Municipality of Wainfleet: Cities include Wainfleet, Lowbanks

Municipality of Welland: Cities include Welland

Municipality of West Lincoln: Cities include Binbrook, Caistor Centre, Canfield, Grassie, Smithville, St. Anns, Wellandport
Secondary Contact Name
The Secondary Contact is the person who will be contacted if the Primary Contact cannot be reached.
Title First Name Last Name
Secondary Contact Email
Secondary Contact Phone Number

Applicant's Name*
This is the name of the individual who would be attending the program, if accepted.
First Last
Applicant's Preferred Pronouns
(i.e., he/him, she/her, they/them, etc.)
Applicant's Gender
- Female
- Male
- Non-Binary
Birth Date (dd/mm/yyyy)*
DD slash MM slash YYYY
Age*
Grade*
School Board*
Please Specify:*
School

Does the applicant have a formal diagnosis of a learning disability? (i.e. reading disability (dyslexia), math disability (dyscalculia), writing disability(dysgraphia))*
Please visit the website for the definition of a learning disability.
- Yes
- No
- I don't know
Type of LD:
Who made the diagnosis?
When?
Note: To be accepted into the program the applicant does not have to be formally diagnosed or identified with a learning disability, but must show signs of having a suspected learning disability.
Is the applicant diagnosed with other exceptionalities?*
(i.e. AD(H)D, OCD, Autism, Auditory Processing Disorder, Intellectual Disability)
- Yes
- No
Please list all exceptionalities and dates of diagnosis.*

Applicant's special interests, abilities, hobbies, sports?*
i.e. baseball, swimming, art, video games
What embarasses the applicant most?
i.e. difficulties in group setting, being singled out
How does the applicant function in a group setting?*
(i.e. better one-to-one, is shy in a group etc.)
Does the applicant display verbally aggressive behaviour?*
(i.e. swearing/insulting others/disrespectful language)
- Yes
- No
Please provide further detail:
Other than verbal aggression, if the applicant displays other forms of behaviour issues, please list them in the space provided:
OPTIONAL: Are there any struggles or challenges that the applicant is experiencing that you would like the program staff to be aware of?
(i.e., social, emotional, personal, etc.)
Is there anything else you would like the staff and volunteers working with the applicant to know about them?*

Are you familiar with the Microsoft Teams platform?*
The LDANR uses Microsoft Teams as our online program platform. If accepted into the program, we will use this information to identify individuals who may require additional support accessing the platform.
- Yes
- No
- Somewhat
Please confirm that you would like the applicant to participate in this opportunity by carefully reading and agreeing to the statements of understanding below:
- I confirm that the applicant will have access to a working device (i.e. computer, tablet) with microphone, camera, and internet connectivity.

Waivers and Conditions of Enrollment:
1. I hereby authorize the administration of any and all emergency medical attention that the applicant might require as a result of injury or sickness while attending LDANR programs.
2. I hereby agree to comply with the LDANR's policy on anti-discrimination, violence and harassment. This is with the understanding that non-compliance may result in my/my child's removal from LDANR programming.
3. I hereby release the LDANR, its directors, staff, agents and members from any loss, personal injury, accident, misfortune or damage to the above-named or his/her property, with the understanding that reasonable precautions shall be taken to ensure the health and safety of the above-named applicant.
4. I understand that the information collected on this form will only be used to assess the applicant's eligibility for programming, to make the LDANR aware of any medical or allergy concerns for the applicant, and to ensure safe pick-up and drop-off of the applicant. This information will only be shared with LDANR staff and volunteers.
5. I understand that for the program to be effective, and out of respect for the program volunteers and those who did not get a spot in the program, LDANR requests that participants commit to attending each session of the program. If attendance is irregular or too many sessions have been missed the participant will be asked to leave the program to open the spot up to another participant.
6. I understand that for the safety of the volunteer staff and other participants, LDANR has the right and responsibility to take actions such as phone calls home and possible dismissal from program if a participant exhibits continual inappropriate behaviour.
7. I understand that for a program to run, enough eligible participants have to apply for the program. If there is low enrolment, the LDANR has the right to cancel any program at any time.
8. I understand that, if the LDANR must cancel a program date due to circumstances outside of their control (e.g., inclement weather), no refunds will be issued. The LDANR will make an effort to reschedule the cancelled session where possible, but there is no guarantee that a cancelled session will be made up.
9. I understand that data is collected from LDANR programs to be used when reporting to funders/sponsors. All information used for reporting purposes is kept confidential and only used by LDANR staff. Participant names are removed and participant data is kept anonymous. Possible data sources used for reporting purposes include test scores, pre and post tests, ages, type of LD diagnosis. If you do not wish for the applicant's assessment data to be used for research purposes, please make note in the comment section below, or contact the LDANR office.
10. I understand that any online programming will take place through a third-party, web-based learning platform. LDANR will not be held liable in the event of a privacy or security breach related to the third-party.
APPLICATION FORMS THAT ARE INCOMPLETE OR THAT DO NOT HAVE THE RELEVANT SUPPORTING DOCUMENTS WILL NOT BE ACCEPTED.
I have read and hereby accept the above waivers and conditions of enrolment and give the LDANR permission to share the applicant's information with the appropriate staff and program volunteers.*
- I agree
Please type your name in the space below to confirm that you have read and agree to the waivers and conditions of enrolment:*
Supporting Documents
If you have the applicant's supporting documents on hand, you can upload them in the space below. If not, the documents can be emailed/scanned to the program coordinator after you have submitted the application.
Supporting documentation may include any of the following documents: the applicant's Individual Education Plan, Report Card, Post-Secondary Accommodations, Psycho-Educational Assessment, Functional Limitations Form etc.
Drop files here or

Max. file size: 20 MB, Max. files: 4.
Questions or Comments
If you do not receive a confirmation/thank you message after submitting your application please contact the office at info@Ldaniagara.org to ensure we received it.
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