Thank you for deciding to move forward with the educational testing process with Jenny Ponzuric.
Below, you will find a link to all of the forms that will need to be completed before our first testing session.
Should you have any questions about the forms, reach out to Jenny via email at firstname.lastname@example.org or by phone (818) 481-6089.
I look forward to our work together.
Form #1: Consent to the educational testing
Please download, print, and sign this document. Bring it to the first day of testing.
Form #2: Email Authorization
Please let me know if you agree to communicate via email. Download, print and sign this form and bring it to the first day of testing.
There is a separate form for students who are under the age of 18 (pink button) and those that are 18 and older (blue button).
Form #3: Social Media Policy
Download, print, and sign the social media policy document. If the student is over the age of 13, please have them sign as well. If you are over the age of 18, please complete.
Form #4: Notice of Privacy Policies
Please download, review, and print the notice of privacy policies. Bring this to the first day of testing and we will all sign the document.
Form #5: Release of Information
Please complete a separate copy of this form for each person you would like for me to be in contact with as part of the educational testing. I typically like to be able to access school records, so please complete a form for the school; alternatively, you can bring in a copy as well. If there is anyone additionally that you think would be helpful to contact (therapist, educational therapist, etc.), please complete a form for that person as well.
Form #6: Background Information
Please download and complete the attached form to the best of your ability. One essential piece of educational testing is having a complete picture of the student, which starts with background information.
There are two options to complete this form. If you like to type directly on the form, download the “fillable” form (blue button). If you would prefer to print the form and write directly on it, please download the “write-on” form (pink button).
Form #7: COVID Informed Consent
Please download and print this form. Both parent and student will need to sign the last page. Parent will need to place initials in all requested areas on pages 1-2.
For clients over the age of 18, please sign the form and place initials in all areas on pages 1-2.