Adult Literacy Ohio - Interest Form

Adult Literacy Ohio is designed to connect adults with developmental disabilities with educators who can build on reading abilities and address gaps in reading skills to improve literacy outcomes, enhance self-confidence, and increase quality of life. Our goal is to meet each learner where they are; administering 1:1 instruction based on the needs, interests, and goals of each learner within the scope of three categories: community navigation, workplace development, and quality of life. Tutors work in partnership with the adult learner and their family to establish two goals for each session.

The size, scope, and parameters for participation in this program are subject to change based on funding sources. If you are an adult with a developmental disability (or supporting a person with a developmental disability through this process) and you are interested in this program, please fill out this form.

As our team works to secure additional funding sources, we will notify you if and when an opportunity becomes available in your area.

With questions, please reach out to info@adultliteracyohio.org.

Thanks!

Name of Adult Learner *

First Name

Last Name

Name of Parent / Guardian

First Name

Last Name

Relationship to the learner you are applying for**

Self/Mother/Father/Grandparent/Legal Guardian

Email*

Phone*

Date

Please enter date of birth of adult learner.

County of Residence *

What do you hope to gain from participation in the Adult Literacy Ohio Program?*

How did you hear about Adult Literacy Ohio?*

As we explore different funding sources and program models, we want to hear from you! What program models do you like? Please check all that apply. *

In-Person Tutoring Two Times a Week In-Person Tutoring One Time a Week with Daily Assignments Self-Pay (Please note that grants are currently 100% state or organization funded)

Other:

Are you a member of The Down Syndrome Association of Central Ohio?

Yes No