Learner Information

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Kindly complete the information sheet as accurately as possible.

Title

First Name

Last Name

Email Address

Contact Number

Current Residential Province

Current Residential City

Current Residential Suburb

What does the student need assistance with?

Learning Barriers School University

Which learning barrier do you need assistance with?

Dyslexia Dyspraxia Dysgraphia Dyscalculia ADD/ADHD Other

What grade is the student in?