The Wake • Kendall Group PLLC
Psychological & Educational Services

 

ADMISSIONS TESTING INFORMATION FORM

 

Child's name ________________________________________________________________

Date of birth _____________________________________ Age _______________________

 

Parents' full names and address(es):

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

Telephone numbers ____________________________ ____________________________

E-mail address _____________________________

What is the best way to reach you? ___________________________

 

Has child had previous admissions test? ____________ yes _____________ no

If yes, date of test (month and year) __________________________________

 

Signature _________________________________________________________

Date __________________________________