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Application Forms

Applications to Achieve must include the following parts to be considered complete:

Case Information Form
Professional Reference Form
Records Disclosure Consent Form
Previous Psychoeducational Evaluations (documentation of learning disability and/or ADHD, including IQ scaled scores and standard scores)
Application Fee

The first three items are downloadable from this page (see the links below). You will need to send copies of previous evaluations. The application fee is $50.00, which should be made payable to the Clinical Center Achieve Program. All application materials, including the Case Information Form, the School Record Form, the Records Disclosure Consent Form, previous psychoeducational evaluations, and the application fee should be mailed to:

The Clinical Center Achieve Program
870 Lincoln Drive
Northwest Annex, Wing C room 116
Mailcode 6832
Southern Illinois University at Carbondale
Carbondale, IL 62901

An application is not considered complete until all requested information is received. All complete applications are reviewed on a first come, first served basis. If for any reason the links to the application materials are not active, please write to the above address and request an application packet, or click on the "Request Information" link for our contact information.

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