Educational Testing Study Question Title * 1. Please tell us about yourself. First Name Last Name Email Phone City State Zip Question Title * 2. What is your gender? Male Female Question Title * 3. Do you have any children under the age of 18? Yes No Question Title * 4. How many children do you have under the age of 18? Question Title * 5. Please tell us about your child or children (For example - 3 children: Name: Julie, Kenny, Lenny; Gender: Female, male, male; etc): Child's Name Gender Date of Birth Grade School's Zip code Ethnicity Question Title * 6. Has your child or any of your children been diagnosed with a psychological, behavioral, and/or learning disability (i.e. ADHD, depression, developmental disorder)? Yes No I don't know Question Title * 7. If your child is under the age of 18, they must be accompanied by a parent to the educational testing. Are you willing and able to accompany the child to an in-person, 20-minute educational testing appointment in the Flatiron District? Yes No Done