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.
Student's Last Name *
Student's First Name *
School Name *
Parent / Guardian Full Name *
Home Phone
Format: XXX-XXX-XXXX
Cell Phone: *
Format: XXX-XXX-XXXX
Contact Email Address *
Student's School Type *
If Public, Please list District (i.e. Dallas ISD)
Gender *
Age *
Current Grade as of Sept. 1st *
Race *
For Nonprofit tracking only.
Required
City *
State *
Zip Code *
What subject(s) are you interested in enrolling your child in? Please check Below: *
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".
Desired Assessment Day *
If the listed days don't work for you, please specify preferred days in "Other".
Required
Desired Assessment Date *
Please only select MONDAY and/or TUESDAY from calendar.
MM
/
DD
/
YYYY
Desired Assessment Time *
Required
Does your child enjoy reading outside of school assignments? *
Please specify Favorite genre / Types of books.
Explain any Reading Concerns:
Does your child enjoy math and science in school? *
Explain any Math Concerns:
Does your child have any special needs? *
If yes, What are the Special Needs?
What is the last topic your child was studying in Math? *
Required
Did your child take the STARR exam last school year? *
If yes, did they pass or fail Math?
Clear selection
If yes, did they pass or fail Reading?
Clear selection
Was the exam modified?
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?
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