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Today's Date
Name of student
Age
Date of Birth
Parents' names
Address
Email Field
Home phone
Work phone
Cell
Current Grade Level
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Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Applying for:
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Current School Year 2023-24
Next School Year 2024-25
Previous school
Date/Grade entered TCA
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Item One
Item Two
Item Three
If applicable, date first entered Lower School Learning Lab
Describe your child's academic progress
(grades, strengths, weaknesses, when difficulty first became noticeable)
Previous special help programs and support:
Does you child currently recceive any outside tutoring?
Yes
No
If so, by whom?
Subjects tutored in:
Would you be in favor of outside tutoring if needed?
Yes
No
What extracurriculars and/or sports is your child involved in?
Text Field
Is your child on medication?
Does your child have current testing (within 3 years) documenting a specific learning disability based on State of Texas Guidelines and/or ADHD?*
Yes
No
If so, name of tester:
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required
Date of testing
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required
Child's age and grade at time of testing
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required
Diagnosis
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required
Please state the reasons you desire your child to be enrolled in the Learning Lab.
Please send a confirmation email to the address below*: