| Parent name: | |
| Child's age: | |
| Child's grade (if applicable): | |
| Email: | |
| Phone: | |
| Address: | |
| City: | |
| State: | |
| Zip code: | |
The improvements that
I am most looking forward
to my child experiencing are
(check all that apply): | concentrating and focusing for longer periods of time |
| performing at a higher academic level |
| initiating constructive, independent behavior |
| comprehending text and verbal language with greater speed and ease |
| gaining social and academic confidence |
| remembering information with ease |
| controlling impulsive feelings and maintaining greater self-discipline |
| thinking quickly and efficiently |
| solving problems, both mathematical and social, with accuracy and confidence |
| participating in classroom discussions and activities more frequently |
| confronting new challenges with a healthy, positive attitude |
|
other (please specify) |
Additional information (areas of concern such as ADD or ADHD, diagnosed learning disabilities, areas of academic struggle): | |
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