Screening Registration Form

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Email *

Student's Name *

First and last name

Date of Birth: *

YYYY

Current Grade: *

Has your child been retained? *

Yes

School name: *

Does your child have an IEP, 504 plan, psychological educational evaluation, neuropsychological evaluation? (Check all that apply) If yes; please email a copy to info@learninglabfl.com *

IEP

504 Plan

Psychological Educational Evaluation

Neuropsychological Evaluation

None of the above

Required

Have your tried other tutoring programs? If so, what programs?
*

Do you already have a session booked for the screening?
*

Yes

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