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Educational Assessment Inquiry Form
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Your Name
Your answer
Your Email
Your answer
Your Student's Name & Grade
Your answer
What academic concerns do you have for your child?
Your answer
What goals do you have for your student?
Your answer
Why are you seeking out an educational assessment for your child?
Your answer
What subjects would you be interested in having your child assessed in?
Dyslexia
Reading
Writing
Math
Oral Language
If Dyslexia, what symptoms of dyslexia does your child exhibit?
History of dyslexia or reading problems in the family
Reading is slow and laborious
Writing is slow and laborious
Spelling is difficult to master
Frequently loses place on the page, skips lines, rereads lines, etc.
Letter, number, and word reversals occur often ("b" as "d" or "saw" as "was")
Rhyming words are difficult to identify
Multi-step directions are difficult to follow
Struggles with directionality (right, left)
Has challenges putting thoughts into words
Clear selection
Are you located in the Denver Metro Area?
Yes
No
Clear selection
If you indicated yes above: where in the Denver Metro Area are you located?
Your answer
What days and times work best for scheduling an assessment? (We will finalize official times later!)
Your answer
Is there anything else that would be helpful for me to know about your student before we meet?
Your answer
Who referred you to Apex Learning Solutions?
*
Flat Irons Tutoring
Reliable Tutoring LLC
Google
Nextdoor
Instagram
Other:
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