» Provider Application - IDA Service Providers

1. Login Profile

Enter Your Member ID *

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 the exception of 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/)

Online Provider

5. Documentation/Biography

Professional Biography *

Enter a brief professional biography.

Resume

Upload your resume ( PDF, 3MB Maximum).

File name:

File size:

Certifications/Education 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

By my signature below, I certify and attest that all my statements and representations I have made in this form are true and I have all credentials, education, degrees, licenses and/or certifications that are legally or customarily required in my field to perform the services I have checked off on this form.

Further, I certify and attest that the credentials, education, degrees, licenses and/or certifications are current and have been issued by an institution or body accredited or empowered to do so. Additionally, I certify and attest that I have not been convicted of any felony or crimes involving professional malfeasance or abuse of any kind.

I also acknowledge that a disclaimer will accompany any information disseminated by The International Dyslexia Association (IDA) which indicates that all service providers listed in the database have signed this verification statement.

I understand that listing in the IDA database requires membership in the IDA and is at the COMPLETE AND SOLE DISCRETION of IDA.

By submitting this application, I agree to accept IDA’s determination regarding this listing request.

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