Download Referral Packet

  1. Download and print the first three sections of the Referral Packet below.
    • High school seniors must also download section 4.
    • Refer to checklist for items not included in download that you must provide
  2. Fill out Referral Packet completely.
    • Refer to checklist explanations in Section 1 if you are not clear about certain items.
  3. Return completed Packet to:

Tasha Falkingham
Regents' Center for Learning Disorders
331 Milledge Hall
Athens, GA 30602-5875

Please note: Incomplete Referral Packets will result in a delay in scheduling.


Download Section 1

Section 1 includes the informational letter, the referral packet checklist, the explanation of checklist items, the RCLD refund policy, and the release of information.

Download Section 2

Section 2 includes the case history.

Download Section 3

Section 3 includes the credit card agreement form, several behavioral rating scales, and the Adult Reading History Questionnaire.

Download Section 4

Section 4 is only required if the student is still in high school. Section 4 includes the high school informational letter, the high school referral packet checklist, the high school explanation of checklist items, the RCLD refund policy, and the high school release of information.

 

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