Luke Waites Center for Dyslexia and Learning Disorders

Thank you for your interest in the Luke Waites Center for Dyslexia and Learning Disorders. To submit an application for your child to be evaluated, please follow the steps below.
Note: If your child is approved to be evaluated at Scottish Rite for Children, there is an evaluation fee of $900 due before testing. Scottish Rite offers a financial assistance program called Crayon Care, and all families are encouraged to apply to help reduce their portion of this fee.

Step 1

Request access to the secure online application by completing the form below.

Step 2

Within 2-3 business days, you will receive an activation link allowing you to access and submit your child’s application.

Be prepared to provide copies of prior testing / evaluation, any relevant school documentation and a copy of your identification (driver’s license, passport, etc.).

Step 3

After you submit the application, the Application Committee will review it and mail you a letter within 3 weeks.

Application Request Form – Step One

You are going to be given access to an easy-to-use online tool to securely submit your child's information.  Before you start, please be aware that:

• Access can only be given to a parent or legal guardian.
• Your child must be:
• a Texas resident
• between the ages of 5 and 14 years
• a proficient English speaker 		✓
✓
✓

If you are a parent or a legal guardian who would like to receive an application to the Center for Dyslexia, please complete the following information.

The child’s biological/adoptive parents are:
With whom does the child primarily reside? (You can check more than one box)

Parent 1 / Guardian / Legally Responsible Person Information
 

Date of birth of the parent or legal guardian.

Sex
Do you have an existing MyChart account with Scottish Rite?
Parent 2 / Guardian / Legally Responsible Person Information
 

Date of birth of the parent or legal guardian.

Sex
Do you have an existing MyChart account with Scottish Rite?
Child's Information
 
Sex
Parent 1 Relationship to Child
Parent 2 Relationship to Child
Legal guardian for this child is?

 
Additional Child’s Information

Only enter information here if you’d like to have an additional child evaluated.


 
Sex
Parent 1 Relationship to Child
Parent 2 Relationship to Child
Legal guardian for this child is?

 
Certification

I certify that I am the patient or legally authorized representative of the patient. By signing this form, I acknowledge that I have read and understand this myChart Request Form and I agree to its terms and conditions. I hereby request access to my child and/or children’s online health record.

Certification


If you have any questions, please contact the Center for Dyslexia at 214-559-7815.