I3 Lab School Year Registration Form

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Email *

Student's Name *

First and last name

Date of Birth: *

YYYY

Current Grade: *

School name: *

Allergies: *

If you have any relevant documents such as psychological evaluations, IEPs, or 504 Plans, please send to tequoya@learninglabfl.com and/or aly@learninglabfl.com *

I will send additional documents.

I do not have any additional documents to send.

Other:

Required

Do you plan to request reimbursement from Step Up for Students (Unique Abilities or New World) for Learning Lab services? *

If yes, please enter your Step Up ID Number (STEP ID) to help streamline invoicing for reimbursement:

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