As part of its mission, the Fred J. Wellington Foundation supports families in need of financial assistance, helping them to receive research-based treatment for dyslexia at approved treatment centers. Please complete the following application and return to our offices. Applications are reviewed on a quarterly basis, and notifications will be given quarterly as well:  January 1, April 1, July 1 and October 1.

Contact Information

Name of Applicant:     _______________________________________   Date of Birth_______________

Parent(s) Name(s):    __________________________________________________________________

Home address:  ______________________________________________________________________

City, State and Zip:  __________________________________________________________________

Daytime Phone:____________________________   Mobile Phone:  __________________________

Email Address:  ______________________________________________________________________

Financial Information

Combined 2013 Family Annual Income:                                              $_______________________

Combined Total Liquefiable Funds (includes Savings and Trusts):      $_______________________

Number of Dependents Living at Home:                                               _______________________

Has the applicant been tested for language deficiencies? (circle)              Yes              No

If yes, please list conditions and including dates and treatments: ___________________________


Select preferred treatment center: (circle one)                                 Wellington-Alexander Center

                                                                                                          The Morris Center

I acknowledge that all the information provided above is true.


________________________________________                _____________________________

Signature of Applicant (or Guardian)                                   Date



Please send to:  Fred J. Wellington Foundation, 9821 E. Bell Road, Suite 100, Scottsdale, AZ  85260