Screening Registration Form
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Email *
Student's Name *
First and last name
Date of Birth: *
MM
/
DD
/
YYYY
Current Grade: *
Has your child been retained? *
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 *
Required
Have your tried other tutoring programs? If so, what programs?
 *
Do you already have a session booked for the screening?
 *
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