Interview Request Form

Please fill in this form and complete all parts.
Upon submission, you will be required to pay a non-refundable fee of $350, which is payable by cheque or electronically to:

Claremont Educational Services, Inc.
Admissions, The Claremont School
C-1, 310 Danforth Avenue
Toronto, ON M4K 1N6

If you are human, leave this field blank.

First Name *

Last Name *

Diagnosis of dyslexia
or learning disability by
a doctor or psychologist *

Yes

Dropdown *

Grade Applying For *

Birth Date (dd/mm/yyy) *

Child lives with *

Single Parent

Both Parents

Guardian

Allergies

Medication

Home Address

If available, please upload, or mail us the following:

3 most recent report cards
Individual Education Plan (IEP)
IPRC Information

Home Address

Student First Name

Student Last Name

Home Address *

Home Address

File Upload

Drop a file here or click to upload Choose File

Maximum upload size: 20MB

Parents' Information

Parent 1

First Name *

Last Name *

Parent 1 Address *

Parent 1 Address

Home Phone

Cell Phone

Work Phone

Email *

Confirm Email *

Occupation *

Employer *

Parent 2

First Name

Last Name

Parent 2 Address

Home Phone

Cell Phone

Work Phone

Confirm Email

Occupation

Employer

I am paying the
Application Fee
of CAD$350 *

By Cheque

Online

Credit Card *

Credit Card

Parent 1 address details are being used for the credit card

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“Neil is a different boy from a year ago, not only because his reading is starting to come along, but because he is enjoying school and, once again, believes he can learn and succeed. Honestly, the Claremont School has been a god-send for Neil.”

—Gail Armstrong, Toronto, ON

Our mission is to teach students with dyslexia, so that they may fulfill their considerable potential and gain the skills and self-confidence needed for academic success.

—Evelyn Reiss

A warm and exceptional teacher, Evelyn provided a wonderful overview of the Orton-Gillingham approach in her Associate Level course. I consider it a privilege to have been her student.

—Avital (Tali) Kellerstein, Speech-Language Pathologist, Toronto, ON