New Student Questionnaire
Dear Parent,
Thank you for considering Beacon Hill Preparatory Institute to enhance your child(ren)'s education. Please take a minute to fill out this questionnaire to aid the staff in setting up your child's assessment.
* Required
Student's Last Name
*
Your answer
Student's First Name
*
Your answer
School Name
*
Your answer
Parent / Guardian Full Name
*
Your answer
Home Phone
Format: XXX-XXX-XXXX
Your answer
Cell Phone:
*
Format: XXX-XXX-XXXX
Your answer
Contact Email Address
*
Your answer
Student's School Type
*
Choose
Private School
Public School
Charter
Home School
If Public, Please list District (i.e. Dallas ISD)
Your answer
Gender
*
Choose
Female
Male
Age
*
Your answer
Current Grade as of Sept. 1st
*
Choose
Pre-Kindergarten
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Race
*
For Nonprofit tracking only.
American Indian / Alaska Native
Asian
Black
Native Hawaiian / Pacific
White
Hispanic
Other:
Required
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
What subject(s) are you interested in enrolling your child in? Please check Below:
*
Math Only
Reading Only
Both
What subject are you interested in getting your child assessed? Please prioritize- 1st Choice & 2nd Choice ( Each Assessment is 30 minutes)
*
If Both, please specify the subject prioritization in "Other".
Math Only
Reading Only
Both
Other:
Desired Assessment Day
*
If the listed days don't work for you, please specify preferred days in "Other".
Monday
Tuesday
Other:
Required
Desired Assessment Date
*
Please only select MONDAY and/or TUESDAY from calendar.
MM
/
DD
/
YYYY
Desired Assessment Time
*
5:30pm - 6:00pm
6:00pm - 6:30pm
6:30pm - 7:00pm
7:00pm - 7:30pm
Required
Does your child enjoy reading outside of school assignments?
*
Please specify Favorite genre / Types of books.
Yes
No
Other:
Explain any Reading Concerns:
Your answer
Does your child enjoy math and science in school?
*
Yes
No
Explain any Math Concerns:
Your answer
Does your child have any special needs?
*
Yes
No
If yes, What are the Special Needs?
Your answer
What is the last topic your child was studying in Math?
*
Addition
Subtraction
Multiplication
Fractions
Pre-Algebra
Algebra
Geometry
Calculus
Other:
Required
Did your child take the STARR exam last school year?
*
Yes
No
If yes, did they pass or fail Math?
Pass
Fail
Clear selection
If yes, did they pass or fail Reading?
Pass
Fail
Clear selection
Was the exam modified?
Yes
No
Clear selection
Are there any other special concerns we should know about your child, before being assessed, that you have experienced at school or home?
Your answer
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