Your Name *

First Name

Last Name

Parent/Guardian Name

(if different from above)

First Name

Last Name

Student Name *

First Name

Last Name

Reason/s for referral *

Check all that apply.

Academic Skill Assessment

College/Career Prep

Exceptional Children (EC) Advocacy

Afterschool Activities

Summer Camps

Orton-Gillingham/Dyslexia Tutoring

Subject Specific Tutoring/Homework Help

Internships/Employability Skills

Other

Student Name

First Name

Last Name

Student Name

First Name

Last Name

Student Name

First Name

Last Name

Disclaimer *

OpenDoors Asheville is primarily an education-based organization. We only offer as-needed, temporary/emergency relief for families already engaged in our services. If the referred student is currently in crisis, please dial 211 to find other organizations providing immediate resource assistance. A referral to OpenDoors Asheville is not a guarantee of services. We require each family to follow the intake process before making a final decision as to the best course of action for educational support and intervention. This process may take several weeks or longer depending on current caseloads, the cooperation of agencies concerning information requests, and schedule availability. We aim to provide high-quality services and acknowledge that what is best for a family may be outside the scope of our programming. A decision not to intake a student or family may involve a referral to outside sources. Please check below to indicate that you understand and agree to the above.

I understand and agree with the above statement.