Child's Name *

First Name

Last Name

Parent/Caregiver(s) Name(s) *

First Name

Last Name

Phone

(###)

###

####

Any Official Testing?

Yes

No

Have You Worked With A Tutor Before?

Yes

No

I will use different diagnostic assessments (asking your child to read and spell words, read passages, etc. based on ability and age appropriateness) during our free assessment in order to gauge where your child’s challenges are. Do you agree to this?

Yes

No

I will contact you to set up this free assessment. Do you prefer by phone or by email? *

Phone

Email