2570 N.W.Green Oaks Blvd., Arlington, TX 76012 (817) 226-6222

Prospective Student Biographical Information

Full name of student to be assessed

Address

Height   Weight   Age   Date of Birth:  /   /  

Color of hair   Color of eyes

Ethnic group(s)   SSN: – –

Brothers and sisters

NameAgeGender

Person responsible for charges

Address

Phone – –   Driver license #   and State

Father's name Age

Mother's name Age

Guardian's name Age

Education:

Current grade in school

Name of current/most recent school attended

Address

Please list in chronological order all schools attended, beginning with preschool and ending with most recent school. Include home schooling and any grade repeated.

           Years Grades School