Math Assessment Enrollment

Math Assessment Enrollment

Please fill out the form below.
Parent/Guardian Information
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Relationship to Student*
(i.e. mother, father, guardian, grandparent, etc)
Student Information
Student's Name*

First NameLast Name
Student Gender*
Student Birth Date*

MonthDayYear
Student Grade*
Please choose your child's current grade. If unsure, choose grade based on age, not skill level.
Type of Math*
Please choose your students math level.
Type of Schooling*
Please choose what type of school your child attends.
Student Concerns/Reasons for Assessment *
Please explain in detail why you are interested in a diagnostic assessment, and please detail any relevant student information such as relevant diagnoses, learning challenges, giftedness, etc.
Assessment Information
This assessment uses Let's Go Learn's diagnostic math assessment. By continuing, you agree to purchase the appropriate assessment from Let's Go Learn's website for aproximately $25.
Scheduling

Please choose a date and time for your meeting. You must return the assessment results at least 72 business hours in advance of our meeting, so make sure you pick a date far enough in advance that your student can take the assessment and return it with enough notice.
Results Meeting*
Purchase Assessment*
prevnext( X )
1:1 Diagnostic Math Assessment
$97.00 Quantity

Total

$0.00
As a reminder, each assessment you purchase includes:
- One 45-minute zoom meeting to discuss assessment results and ask questions for a more well-rounded final report (both parent/guardian and student should be present).
- A fully-detailed pdf report with your studnet's strengths & weaknesses, lesson plan to fill in gaps or extend learning, resources to assist in filling gaps, and answers to any questions you have.
Following your purchase you should expect:
- An email confirming your chosen time, a link to purchase the assessment, any additional questions I might have, and a link to the Zoom meeting.

Payment Methods

Debit or Credit Card

Please click one of the PayPal options to complete payment and submit the form.

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Math Assessment Enrollment

Parent/Guardian Information

Student Information

Assessment Information

Scheduling