Academic Assessment Inquiry
Please complete the following information.
Parent/Guardian First Name
Parent/Guardian Last Name
Parent/Guardian Email
Parent/Guardian Mobile Phone
Address
Address Line 2
City
State
Zip
How did you hear about Launch Learning Clinic?
Friends
Family
Doctor Referral
Website
Social Media
Other
How would you prefer to be contacted?
Phone call
Text message
Email
Testing Client Information
First Name
Last Name
Birth Date
Current or most recent grade completed
Does the client have an IEP? And/or, have they previously been tested for a learning disability? Please describe , and send us a copy of any IEP or evaluation.
Describe your reason for seeking an academic assessment
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