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Direct-2-Family February 2024 Literacy Assessment Application
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Email *
Name of Student *
Student's Grade *
Name of Parent/Caregiver *
Phone number *
Email *
Address *
County *
Has your child had any previous testing from either a public school or private organization (Please include the place where your child was evaluated)? *

Did your child receive a diagnosis of a learning challenge (please include diagnosis)?

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Has  your child received a diagnosis of any of the following: (ADHD/ADD, Autism, Dyslexia)? If other, please specify.

 *

Has your child received an eye exam in the last year?

 *

Has your child received an eye exam in the last year?

 *

Please include any other information that might help us assist your child's learning.

 *
Which assessment option are you interested in? *
Please select the interested Assessment Date *
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