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 *
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 *
If Public, Please list District (i.e. Dallas ISD)
Your answer
Gender *
Age *
Your answer
Current Grade as of Sept. 1st *
Race *
For Nonprofit tracking only.
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: *
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:
Your answer
Does your child enjoy math and science in school? *
Explain any Math Concerns:
Your answer
Does your child have any special needs? *
If yes, What are the Special Needs?
Your answer
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?
If yes, did they pass or fail Reading?
Was the exam modified?
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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