FORM INSTRUCTIONS

Provide:

Test date and name of examiner.
Family information, parent names, mailing address (to receive test materials/test results), and email.
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.
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.
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

Test Date*

Examiner*

Name

Parent and Contact Information

Parents' Names

Name(s)

Parents' Email*

Mobile or Work Phone

Home Phone

Mailing Address

Street Address Apt, Suite, Unit, Bldg City State / Province / Region ZIP / Postal Code Country

Students

First Student*

Student's Name

Grade Level for Testing*

Date of Birth*

Performance Evaluation Report*

Yes

Second Student

Student's Name

Grade Level for Testing

Date of Birth

Performance Evaluation Report

Yes

Third Student

Student's Name

Grade Level for Testing

Date of Birth

Performance Evaluation Report

Yes

Test Selection and Order Total*

Order Test(s)

Quantity

Order Test(s)

Quantity

Order PER(s)

Quantity*

Total

*If any special pricing is active, the discount(s) will be applied at checkout even if regular prices are displayed.

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Online Semi-Private Survey Plus Test

FORM INSTRUCTIONS

Provide:

Test Week and Parent/Guardian Name

Parent and Contact Information

Students

Test Selection and Order Total*

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