Appointment Request
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Please fill out this form completely, and allow plenty of time to schedule your appointment request.
Testing is approximately two hours long.
You will be provided with a completed copy of this form.

Student's Name:


Birthday:


Current Grade:
Birthplace:
U.S. Enter Date:
Enter Date U.S. School:
Enter Date CA School:
Last School Attended:
City, State:
School District:
Enter Date CA School:
Telephone Number:
Fax Number:
Contact Person:
Has your child previously attended any school in the AUSD?: Yes No
Current Alvord USD School of Residence:
   Elementary   Middle   High
Parent/Guardian's Name:
Telephone Number:
Requested By:
Appointment Date:
Will you be in need of: Testing Service Translating Service Or both
What is the main language spoken at home:
Does your child know English?: Yes A little bit No
What time block would you like schedule your appointment?
8:00-10 a.m. 10:00 a.m.-12 p.m. 12-2 p.m. 2-4 p.m.

Is your child a Special Needs student.................? Yes No
Other Comments?

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