Mail In Scheduling Form - to be used for WOODCOCK-JOHNSON III SCHEDULING - not required for online credit card orders.
BASIC $55 (INCLUDES THE 6 AREAS REQUIRED BY NC AND MOST STATES)
You may choose either Reading & Math Fluency (grades 3-12) or Academic Knowledge (grades K-12) at no additional charge.
PARENT'S NAME_____________________________________________________________________________________________________________
STREET ADDRESS__________________________________________________________________________________________________
CITY ____________________________STATE ____________ZIP___________ EMAIL___________________________________________
HOME PHONE __________________________ CELL PHONE _________________________ OTHER PHONE_________________________
TEACHER NAME(S)__________________________________________________________________________________________________
SCHOOL NAME (OPTIONAL)__________________________________________________________________________________________
Notes:______________________________________________________________________________________________________________
Student's Name Grade Date of Birth
____________________________________________________________________ - ____________ - _____________________________
____________________________________________________________________ - ____________ - _____________________________
____________________________________________________________________ - ____________ - _____________________________
____________________________________________________________________ - ____________ - _____________________________
____________________________________________________________________ - ____________ - _____________________________
PLEASE LIST ANY ADDITIONAL TESTS YOU DESIRE ($5 each) ______________________________________________________________
___________________________________________________________________________________________________________________
WHICH MONTH DO YOU PREFER? (PLEASE CIRCLE) JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
WHICH WEEK DO YOU PREFER? (PLEASE CIRCLE) 1ST 2ND 3RD 4TH 5TH
WHICH DAYS ARE BEST FOR YOU? (PLEASE CIRCLE) MON TUE WED THU FRI SAT
WHAT TIMES ARE BEST FOR YOU? AM ___ PM ___ DOESN'T MATTER ___
DO YOU HAVE A PREFERENCE OF WHICH FORM YOU WANT USED? FORM A ___ FORM B ___
Please note: We will do our best to schedule your testing at a convenient time for you.