Agreement to Schedule Assessment

I authorize testing and assessment of  as part of the admissions process for placement at Gateway School.

The fee for the assessment is $700.00. This includes a non-refundable fee of $50.00 to schedule the examiner’s time. If the examiner reschedules, there will be no additional charge. If you or your child reschedules, and the examiner is notified at least 24 hours in advance, there will be no additional charge. If you or your child reschedules and the examiner was not notified at least 24 hours in advance, there will be an additional $50.00 rescheduling fee.

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Student signature (if 18 or older)Parent/Guardian signature

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I/we agree that the examiner may review previous assessment data that I/we have provided.

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Student signature (if 18 or older)Parent/Guardian signature

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Date