To download a copy of our “Parent/Guardian Consent for a Comprehensive Educational Evaluation” in a Microsoft Word document (.doc) version, simply click here. The form will automatically download to your device or computer.
Please return your completed form by email to firstname.lastname@example.org
PARENT/GUARDIAN CONSENT FOR A COMPREHENSIVE EDUCATIONAL EVALUATION
STUDENT’S NAME: ____________________________________
STUDENT’S DATE OF BIRTH: _____________
I give my consent for Dr. Laurie Hoke to complete a comprehensive educational evaluation for my child:____________________. I understand that the following components will be completed:
Social and Health Developmental History ___
Formal Academic Assessment ___
Formal Cognitive Assessment ___
Behavior Rating Scales ___
ADHD Rating Scales ___
I understand that this evaluation will be completed in a timely manner. I understand that I will be provided with a full written report that will provide all tests administered in addition to test scores and a score analysis with recommendations for my child and his/her school. I understand that I may revoke this consent at any time by providing my request in writing.
Parent Name (print):______________________