» Provider Application - IDA Service Providers

1. Login Profile

Setting up your account

To add your professional listing to this directory and update it any time, you’ll need to create an account. If you already have an account, enter your email and password to update your listing whenever you want. If you’re setting up your account for the first time, enter an email and password to access your account.

Login Email *

Login Password *

Select a Security Question *

The Answer to Your Security Question *

2. Public Contact Data

First Name *

Middle Initial

Last Name *

Suffix

Phone

Email *

Website

Photo

Upload a square, close cropped profile (250x250 pixel) or company logo (jpg).

3. Location

Enter your address and select it from the drop down list to pinpoint your location this Google Map. The location you select will appear on when someone searches for a provider in your area (with expections virtual providers)

Street Address

Street Address 2

City

State/Province

Zip/Postal Code

Country

4. Services

Professional Services *

Scroll and check all that apply.

Populations Served *

Select all that apply.

Adults
Children
Multilingual

Additional Languages

Please list non-English languages in which you provide services.

Accepting New Clients

Select if you are accepting new clients.

Accepting New Clients

Private Liability Insurance *

Yes
No

Knowledge and Practice Standards *

I hereby acknowledge that I observe and practice the Ethical Standards as described in the Knowledge and Practice Standards. (To view the Knowledge and Practice Standards, please visit: https://dyslexiaida.org/knowledge-and-practices/)

5. Documentation/Biography

Professional Biography *

Enter a brief professional biography.

Resume

Upload your resume ( PDF, 3MB Maximum).

File name:

File size:

Certifications/Eductation Degree

Select "Add Certification" for each certification or degree to be included in your profile.

State License Proof

Upload your State License (PDF).

File name:

File size:

Total Years of Professional Experience

6. Sign and Submit

Application Review

This is your opportunity to review the information you have provided on your application. Select any tab at the top of the application to return to that screen and edit the information before signing below. Once you have completed and reviewed the application, type your name to approve the application and authorize publication of your professional profile in the IDA provider directory.

E-Signature *

Authorization *

A check indicates that you agree to public search and display of my profile.

I agree to public search and display of my profile