Welcome to Apples of Gold
Please take a little time to complete this online form about your child. This information will help Elizabeth prepare for your complimentary meeting. Any information you share is confidential and will be maintained with the utmost regard for your privacy.
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Parent's First & Last Name *
Primary Email *
Primary Phone Number *
Your Child's First Name *
Your Child's Last Name *
Child's School *
Child's Grade *
Child's Date of Birth *
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DD
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Child's Gender *
Current Address *
City *
State *
Please describe your child's strengths. These strengths and abilities may relate to your child's personality, character, interests, talents, and/or learning: *
Please describe your child's previous and current academic difficulties in reading, spelling, writing, handwriting, and mathematics (as applicable): *
Please describe your child's previous and current challenges related to memory, reasoning, attention span, and learning: *
Please describe your child's previous and current challenges related to attention, organization, priority-setting, and study skills (as applicable):
Please identify all customized instruction services you may be interested in for your child: *
Required
Please identify the assessment services you may be interested in for your child: *
Required
How did you hear about Apples of Gold?
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