You can request an appointment for our comprehensive, interdisciplinary assessment or a consultation by completing our Contact Form. You may complete this form online, download the form below and mail or fax it, or call to discuss our services and request a contact form via regular mail.
Click here to begin completing our online Contact Form
Click here for a printable version of the Contact Form
Click here if you are seeking services for yourself
In order to process your request as quickly as possible we ask that you please note the following procedures:
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You will receive an automated response from The Yellin Center for Student Success to confirm receipt of your Contact Form.* |
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Our staff will review your contact form to determine if our services are a match for the student's situation and referral concerns. We may contact you to discuss additional questions or to clarify your responses. |
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You will be contacted via phone, email or regular mail regarding your Contact Form submission. If you have a preferred means of contact please notify us via the Contact Form. |
The information collected on the following pages is confidential and necessary in order for us to determine whether our services will meet the needs of a student. It will take several minutes to complete.
We will ask you questions about the following topics:
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Specific concerns about learning |
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Estimate of academic skill levels |
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Previous assessment findings |
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Current services and supports |
You may need to review school reports or prior assessments to respond to some of the questions we ask.
Important note: you may lose data you have entered if you leave this process for an extended duration due to browser time-out.
Click here to check the status of a submitted Contact Form
Click here to download Acrobat Reader
* Please be sure to add the mail domain name “@yellincenter.com” to your email safe list to ensure your receipt of important emails concerning your contact form submission.
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