Consultation & Assessment Request

Consultation & Assessment Request

Tell us a little about your family and what you have noticed. You do not need to know what kind of help your child needs. Our assessment will help us understand their strengths and next steps. Request an assessment for up to 5 students. Questions marked * are required.
Parent/Guardian Full Name
Relationship to Student(s)
Please describe your relationship. (optional)
Mobile Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Preferred Communication Method
Preferred Language for Family Communication (optional)
Which language are you most comfortable using when communicating with ALC?
Preferred Language for Family Communication
Which language do you prefer?
Please use this if you selected Other above.
How did you hear about Alley-Oop Learning Center?
Please tell us how you heard about us. (optional)
Please use this if you selected Other above.
How did you hear about Alley-Oop Learning Center?
Please tell us how you heard about us. (optional)
How many students would you like ALC to assess?

Student 1 First Name
Student 1: Is there anything you would like us to know about how school has been going? (optional)
Student 1: Has a teacher or school shared any concerns or recommendations? (optional)
Student 1 Last Name
Student 1 Current Grade
Student 1 Current School
Enter Homeschool if applicable. If not enrolled, enter Not enrolled.
Student 1: Is there anything you would like us to know about how school has been going? (optional)
A short answer is fine. You may also leave this blank and discuss it with us during the consultation.
Student 1: Does this student currently receive any additional support at school? (optional)
Student 1: What made you decide to reach out to ALC for this student?
Student 1: Is there anything you would like us to know about how school has been going? (optional)
A short answer is fine. You may also leave this blank and discuss it with us during the consultation.
Student 1: Has a teacher or school shared any concerns or recommendations? (optional)
Student 1: Has a teacher or school shared any concerns or recommendations? (optional)
A sentence or two is enough.
Student 1: What did they share? (optional)
A short answer is fine. We can also discuss this during the consultation.
Student 1: Does this student currently receive any additional support at school? (optional)

Student 2 First Name
Student 2 Last Name
Student 2 Current Grade
Student 2: Does this student currently receive any additional support at school? (optional)
Student 2 Current School
Enter Homeschool if applicable. If not enrolled, enter Not enrolled.
Student 2: What made you decide to reach out to ALC for this student?
Student 2: Is there anything you would like us to know about how school has been going? (optional)
A short answer is fine. You may also leave this blank and discuss it with us during the consultation.
Student 2: Is there anything you would like us to know about how school has been going? (optional)
A short answer is fine. You may also leave this blank and discuss it with us during the consultation.
Student 2: Has a teacher or school shared any concerns or recommendations? (optional)
Student 2: What did they share? (optional)
A short answer is fine. We can also discuss this during the consultation.
Student 2: Does this student currently receive any additional support at school? (optional)

Student 3 First Name
Student 3 Last Name
Student 3: Does this student currently receive any additional support at school? (optional)
Student 3 Current Grade
Student 3 Current School
Enter Homeschool if applicable. If not enrolled, enter Not enrolled.
Student 3: What made you decide to reach out to ALC for this student?
Student 3: Is there anything you would like us to know about how school has been going? (optional)
A short answer is fine. You may also leave this blank and discuss it with us during the consultation.
Student 3: Is there anything you would like us to know about how school has been going? (optional)
A short answer is fine. You may also leave this blank and discuss it with us during the consultation.
Student 3: Has a teacher or school shared any concerns or recommendations? (optional)
Student 3: What did they share? (optional)
A short answer is fine. We can also discuss this during the consultation.
Student 3: Does this student currently receive any additional support at school? (optional)

Student 4 First Name
Student 4: Does this student currently receive any additional support at school? (optional)
Student 4 Last Name
Student 4 Current Grade
Student 4 Current School
Enter Homeschool if applicable. If not enrolled, enter Not enrolled.
Student 4: What made you decide to reach out to ALC for this student?
Student 4: Is there anything you would like us to know about how school has been going? (optional)
A short answer is fine. You may also leave this blank and discuss it with us during the consultation.
Student 4: Is there anything you would like us to know about how school has been going? (optional)
A short answer is fine. You may also leave this blank and discuss it with us during the consultation.
Student 4: Has a teacher or school shared any concerns or recommendations? (optional)
Student 4: What did they share? (optional)
A short answer is fine. We can also discuss this during the consultation.
Student 4: Does this student currently receive any additional support at school? (optional)

Student 5: Does this student currently receive any additional support at school? (optional)
Student 5 First Name
Student 5 Last Name
Student 5 Current Grade
Student 5 Current School
Enter Homeschool if applicable. If not enrolled, enter Not enrolled.
Student 5: What made you decide to reach out to ALC for this student?
Student 5: Is there anything you would like us to know about how school has been going? (optional)
A short answer is fine. You may also leave this blank and discuss it with us during the consultation.
Student 5: Is there anything you would like us to know about how school has been going? (optional)
A short answer is fine. You may also leave this blank and discuss it with us during the consultation.
Student 5: Has a teacher or school shared any concerns or recommendations? (optional)
Student 5: What did they share? (optional)
A short answer is fine. We can also discuss this during the consultation.
Student 5: Does this student currently receive any additional support at school? (optional)

Assessment Availability

Tell us when your family is usually available. These are preferences, not available appointment slots.
Which days usually work best for an assessment?
What times usually work best?
Anything we should know about your availability? (optional)
For example: weekdays after 4:00 PM or Saturday mornings.
Anything we should know about your availability? (optional)
Submitting this form does not reserve an appointment. The ALC team will contact you to confirm an assessment time.
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