Gravity Forms Test | The Center for Effective Reading Instruction

Applicant Profile Information

Highest Degree Held*

Major*

Upload degree or transcript*

In order to receive certification as a Structured Literacy/Dyslexia Specialist, you must hold a Bachelor's degree or higher. Your degree can be in a field other than education. Documentation must include the name of the issuing institution as well as the year the degree was awarded. Professional licenses are not acceptable. Please upload a copy of your degree or transcript showing completion of your degree. Section max file upload size 5MB.

Drop files here or

Accepted file types: pdf, jpeg, jpg, png, gif, doc, Max. file size: 5 MB.

Are you Applying From an IDA Accredited Institution/Program?*

Yes
No

*If you have not completed an accredited program eligible for the Structured Literacy Dyslexia Specialist (SLDS) certification then you must apply for this certification using an Alternate Route application.

Please Select Name of Accredited Institution / Program*

Year Completed*

Graduate of an IDA Accredited Program*

Upload official documentation of completion of an eligible IDA accredited Independent Teacher Training Program or University Program such as a certificate or transcript. Max file upload size 5MB.

Drop files here or

Max. file size: 5 MB.

Documentation of Practicum and Practicum Hours*

Max file upload size 5MB.

Drop files here or

Max. file size: 5 MB.

Demographic Information

Are you Currently Teaching at a Public or Private School?*

Public
Private

What Grade(s) do you Teach?*

Is your School in an Urban, Priority, or Rural district?*

Yes
No

How Many Students do you Impact in One Academic Year With Structured Literacy in the Classroom?*

Why Did you Seek CERI Certification? (optional)

Additional Information / Comments (optional)

Please include any additional information related to this application.

Applicant Affirmation

IDA Branch*

By checking 'I agree', I give permission for CERI to share my contact information with my local IDA branch

I agree.

Affirmation*

1) I affirm that all of the information provided on this application is true, accurate and fully responsive to the questions asked.
2) I have read and agree to abide by the code of ethics of the Center For Effective Reading Instruction that are found within the Knowledge and Practice Standards for Teachers of Reading (KPS).
3) I agree to abide by all standards required to maintain my certification, including payment of annual fees and participation in continuing professional development activities.
4) I understand that, once certified, my certification status may be made available to the public.

I agree.

Name as Applicant Would Like it to Appear on Certification

Name on Certification*

Please type your name exactly as you would like it to appear on your Certification. (Please do not include designations or abbreviations from other organizations as these will be omitted on your certificate.)

Payment

Have you already passed the KPEERI Exam?*

No
Yes

Legal Name*

The name submitted for the KPEERI exam must exactly match your legal name as it appears on your government issued photo identification. Please enter your name exactly as it appears on your driver's license, passport or other government issued ID.

First (Given) Name Last (Family) Name

When did you pass the KPEERI Exam?*

Please upload KPEERI Score Report*

Max. file size: 5 MB.

Institute or Program Paying for KPEERI Exam*

Please note that institutional payment is subject to verification before an application can be processed.

No
Yes

Approved Programs for KPEERI Prepayment*

Documentation of Institutional Payment*

Max. file size: 5 MB.

If your institution provided you with a voucher or other documentation of their willingness to pay your exam fee please upload it here. (Section max file upload size 5MB.)

KPEERI Exam*

Price:

KPEERI Processing Fee*

Price:

(non-refundable)

SLDS Certification Administration Fee*

Price:

(non-refundable)

Total

$0.00

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Billing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Billing Email*

Billing Phone*

Discount Code

CAPTCHA

Certification App: Structured Literacy/Dyslexia Specialist

Applicant Profile Information

Demographic Information

Applicant Affirmation

Name as Applicant Would Like it to Appear on Certification

Payment