The Evolved Education ELA and/or NYS Math Small Group Class Intake Form
This form will take about 5 minutes to complete. It will greatly help us to best serve your family. We look forward to partnering with you!
Email address *
Your full name *
Your answer
Your phone number *
Your answer
Your child's name *
Your answer
Your child's school *
Your answer
Your child's grade *
Your answer
Which Class will You Sign Up For? (Please note your space is NOT reserved until you pay for the course) *
Required
Please confirm that your child can take the diagnostic exam for the course on January 20th or January 21st. Students will need to take a one hour ELA and a one hour NYS Math Exam. Please click on the date you will take exam and in the notes section, please let us know if you want to split up the exam over two days and/or if your child has extended time or any other accommodations or if he/she cannot come to the diagnostic so that we can make other arrangements. *
Required
Please confirm that your child can attend the simulated, full mock ELA and/or Math Mock Test (included in cost of course) *
Required
Include notes here to let us know about your child's testing accommodations. *
Your answer
Your Child's Development
Please briefly tell us about each area of your child's development. We use this information to ensure that we are addressing all areas of your child's experience as a student. For instance, if your child's work space at home is not conducive to studying, that may interfere with the ability to study independently; or if your child's experience in a class has not been working well, we would want to know about that as well. If you are unsure of any aspect, do not worry; we can help you to uncover information during our intake call and/or as we begin to work with your child.
Please tell us about your child's academic history (strengths and challenges).
Your answer
Do you know your child's learning style or preference? How does your child like to learn? Has your child had any tutoring in the past? To which type of adult does your child best respond?
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Tell us about your child's experiences at school (where has your child gone to school in the past and where does your child go to school now; and, how would you describe each school experience?)
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Tell us about your family values regarding your child's education. What goals do you have for a test preparation program? 
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Let us know if you have any concerns about your child's social, emotional and/or physical development. Please visit www.evolveded.com/sepaq.html to take our free assessment to find out how your child is developing socially, emotionally and physically. Please report your child's score here.
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