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Location (circle date and place):
Lakewood: 3/5 & 3/12 and 4/30 & 5/7;Summit / Tacoma – May 25-27,
2010;
Elma
June 1 & 2, 2010; Other Dates/Places - TBD:
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Test Level
Grade
Student's Name
Birth Date
Grade
14 3.6 -
5.2 ____________________________________________________________
15 4.6 - 6.2
____________________________________________________________
16 5.6 - 7.2
____________________________________________________________
17 6.6 -
8.2 ____________________________________________________________
18
7.6 - 9.2
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19 8.6 -
10.2 ____________________________________________________________
20
9.6 - 11.2 ____________________________________________________________
21/22 10.6 -
12.9 ____________________________________________________________
NOTE: Please put an
asterisk (*) by the name of any child who has never had an achievement test
before. If your child has been
diagnosed with
ADD/ADHD (attention deficit disorder/attention deficit hyperactive disorder)
please indicate with an "ADD" or
“ADHD” by his/her
name.
Payment:
Levels
14-21 Number of students to be tested ______x $40.00
(Individual and small group testing ______ x $50.00) =
Subtotal of Testing
Fees
10%
Discount for three or more children tested Subtotal:
________ x 0.9 =
Scoring done by
administrator – ADD Number of students _________ x
$15.00 =
Total (Enclosed)
Please make checks payable to Ronnie Dail
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For your convenience, we are able to accept Credit Card payment.
We
accept VISA, Master Card or Discover. Call for details.
Refunds for cancellations will be given up to 14 days prior to the
first day of testing.
You
may reschedule with at least One - Week Advance Notice.
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