5125 MacArthur Boulevard, N.W. Suite 16 Washington, DC 20016 Telephone: (202) 363-9805 Fax: (202) 363-9807

To schedule an appointment or to have any questions answered concerning diagnostic or admissions testing, call our office at the number above and choose option #3 in order to leave a message for Elinor Flyer. State your name, child's name and age, and phone numbers where you can be reached. Also note the preferred phone number as well as the best time to reach you. Ms. Flyer will return your call within 48 hours. You may also email Elinor Flyer at ellieflyer@comcast.net with the above information.

ADMISSIONS REGISTRATION FORM After you have scheduled an appointment for an Admissions Assessment, please print this Admissions Registration Form, complete it, and return it, WITH FULL PAYMENT to EAA. Note: If this form does not get printed in total on your printer, click on the "Properties" option on the print dialog pop-up (File then Print from the menu bar), and choose to print this page in "landscape" rather than "portrait" mode. Client Number______________ (Tester will complete number) Date of Assessment______________ Time _____________ Test to be Administered _____________________________ Tester___________________________________________ *Child's Name _____________________________________ Date of Birth _________________ Age _____________ *Parents' Names ___________________________________ *As you wish names to be on the report Address __________________________________________ _________________________________________________ E-mail____________________________________________ Telephone Numbers (H)_______________________________ Cell (Father)   _____________    Cell (Mother)   ______________ Work (Father) ______________ Work (Mother) ______________ Applying for __Pre-K    __K     __Grade___ Present School _____________________City____________ Present Grade or Program ___________________________ Previous Testing?  ____WPPSI-III   ____WISC-IV Date(s) ________________ (Approximately a year should elapse before re-administration of any of these tests.) How did you learn about EAA? _______________________ Fee for WISC-IV: $375, WPPSI-III: $325 for a 3 year old and $340 for  a 4 or 5 year old (Conference included) Cancellation policy: If assessment is canceled 48 hours or more in advance of scheduled date, $25 will be deducted from payment; the balance of the fee will be refunded. If less than 48 hours notice is given, $50 will be deducted. In case of illness, the assessment will be rescheduled. Please note below any information pertaining to your child which you feel would be important for us to know (e.g., language(s) other than English your child speaks at home and/or at school; experience living/traveling in countries other than the United States; work with a speech therapist, occupational therapist, etc. and any special interests/hobbies). _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________

It is important to understand that the WPPSI-III and WISC-IV are protected tests; i.e., knowledge and use of their contents are limited to qualified professionals.  No "practice" or preparation for the tests is needed or allowed. I give permission to Educational Assessment Associates to send the results of the Wechsler Scales and/or Woodcock-Johnson Tests of Achievement to the following schools:* ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ _____________________________ Signature of Parent/Guardian _____________________ Date *Up to four (4) copies of admissions reports will be mailed to schools free of charge. Additional copies will be mailed or FAX'ed at a cost of $5.00 per report.

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - In the event that Educational Assessment Associates is contacted by a school admissions officer who has questions about my child's test results/report, I give my consent for the tester to provide clarification of those results. _____________________________ Signature of Parent/Guardian _____________________ Date