New Student Application

Application Information

Submission of forms does not equate to acceptance into the program.

If you are also submitting a video for assessment, your application will not be considered complete until the $100 video assessment fee is received.

The Conductive Learning Center of North America will notify you regarding acceptance into the program.

Please click here for a printable version of this form.

New Student Application

Step 1 of 4

  • Child's Personal Information

  • MM slash DD slash YYYY
  • Please include names, ages and genders
  • Parent / Guardian Information

Our Mission

To provide opportunities for individuals with motor challenges to achieve optimal physical, cognitive, and social independence through the application and promotion of conductive education principles.