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Contact Us
Home
About Us
Team
Testimonials
Clinical Services
Psychoeducational Evaluations
Specific Learning Disability Assessments for Dyslexia, Dysgraphia, Dyscalculia
Autism Spectrum Disorder
Brain Mapping and Neurofeedback
Attention Deficit Hyperactivity Disorder
Behavioral Interventions and Family Coaching
Social Skills Development
Early Childhood Developmental Assessments
Kindergarten Readiness
Educational Services
Transitions2College
Comprehensive Spelling and Writing Instruction
Sequential Remedial Math Instruction
Intensive Remedial Reading and Dyslexia Instruction
Executive Function Coaching
Study Skills and Organizational Coaching
SAT and ACT Preparation
Patient Forms
Community
CHLA Blog Spot
Workshops & Seminars
Podcasts
Contact Us
Parents Fill Out This Form
Parent T2C PROGRAM Getting Started Questionnaire
Student Name
*
First
Last
Parent Name
First
Last
Parent Email
*
Student’s Primary Home Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Home Phone
Home Fax
Student Primary Residence:
*
Mother & Father
Mother only
Father only
Father's Name
Father's Email
Mother's Name
Mother's Email
Parent(s) Tell Us About Your Student
Please feel free to go beyond the questions we have asked and tell us anything you wish to share about your son or daughter that will help us to get to know your student.
1. What are your desired goals for your student’s post-secondary education placement?
*
2. What assistance do you desire from T2C—why are you seeking the services of an educational consultant?
*
3. What are your student’s post-secondary education goals, (including, but not limited to desired area of study and desired college environment?)
*
4. What do you believe are your student’s strengths and weaknesses as a student? Please include your perception of their study habits, motivations, self-discipline, organization, time-management, self-confidence, passion for learning, independent vs. dependent learning skills, test taking and study skills, special talents, extreme interests and most salient desires, as well as all other facets you believe are relevant to identifying a good college match for your student.
*
5. Does your student have a documented disability? How, if at all, does the disability impact your student’s transition to college planning?
*
6. When was your student’s disability diagnosed and do they have a current special education or accommodation plan?
*
7. What types of accommodations and supports have been provided in high school for your student? Were those accommodations helpful?
*
8. What types of disability accommodations and supports do you believe your student may need in college?
*
What additional things would you like to share about your student (e.g. what does he/she like to do in their spare time)?
*
Email
This field is for validation purposes and should be left unchanged.
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