The case of a 29-year-old university student is used to discuss impairments in decoding skills in older students. Factors are reviewed that contribute to decoding unfamiliar words, such as phonological awareness skills, quality of visual orthographic images, type of decoding strategy used, and morphological awareness skills. The assessment and intervention procedures used with this student highlight the application of current literature when developing assessment and intervention programs for students from middle school and high school to the university level. Additionally, the need is emphasized to recognize and work with the special emotional needs of older students with reading impairments.