EXCEL Program Assessment Registration Form

EXCEL Program Assessment Registration Form
Thank you for your interest in the BWL EXCEL Program. Students can only be assessed for the EXCEL Program if they have applied to or are current students of BWL. Please note that the assessment does not assess academic abilities. Rather, it is a series of puzzle-like tasks and problems that will give the EXCEL Team insight into the student's executive functioning skills.
Student Name*

First NameLast Name
Student's Current Grade*
Date of Birth*

MonthDayYear
Date
Gender*
Is your child a current student at Birch Wathen Lenox School?*

YesNo
If not, current school?*
Parent/Guardian*

First NameLast Name
Parent/Guardian Email*
example@example.com
Parent/Guardian Mobile Number*
Please enter a valid phone number.
Testing begins at 3:30pm. Please arrive to BWL at 3:20pm so we can begin on time.
Choose date of student assessment*

January 16th at 3:30pm

EXCEL Admissions FeeIf your child has a Neuropsych report, IEP and/or IESP please upload them below. Please note admissions fees are non-refundable.

$250.00 Quantity

Total

$0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

By registering for this program, you hereby consent to being contacted by the School for purposes of obtaining information that may be protected by HIPPA and/or FERPA or similar laws and hereby authorize the School to obtain any such information for purposes of eligibility for inclusion in the Excel program.
File Upload

PDF Only
Cancelof
No educational paperworkIn process will send when complete
When complete please forward to excel@gbwl.org.