Online Private Survey Plus Test

FORM INSTRUCTIONS

Provide:

  1. Test date and name of examiner.
  2. Family information, parent names, mailing address (to receive test materials/test results), and email.
  3. Student name(s), and grade level(s) to be tested. Check yes to order the optional Performance Evaluation Report. This report identifies objectives measured by all items on the test.
  4. Total testing fees (covers testing materials, basic report, and Performance Evaluation Report if ordered). Please note an additional processing fee of $8 is included in the price of testing for grades 1, 2, and 3.
  5. Click Submit. Your registration form will be submitted to Basic Skills and you be directed to a payment page.

**If testing two or more students and one student is a first, second, or third grader, it will be necessary to go through the payment process twice: once for students grades 4-12, and again for students grades 1-3.**

"*" indicates required fields

Test Week and Parent/Guardian Name

MM slash DD slash YYYY
Examiner*

Parent and Contact Information

Parents' Names
Mailing Address

Students

First Student*
MM slash DD slash YYYY
Performance Evaluation Report*
Second Student
MM slash DD slash YYYY
Performance Evaluation Report
Third Student
MM slash DD slash YYYY
Performance Evaluation Report

Test Selection and Order Total*

*If any special pricing is active, the discount(s) will be applied at checkout even if regular prices are displayed.
This field is for validation purposes and should be left unchanged.