Please send this portion with your check :

BASIC SKILLS ASSESSMENT & EDUCATIONAL SERVICES
Achievement Test Registration

Father/Guardian____________________________________ Test Date _________________

Mother/Guardian____________________________________ Phone ( ____ )_____________

Mailing Address________________________________________________________________

_______________________________________________________________________________


The diagnostic Profile is an optional report that shows how your student performed in regards to specific learning objectives measured by the test.
Student's
Full Name
Date of Birth Grade Level
for testing
Diagnostic Profile
Yes or No
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
· Please put a * by the name of any student taking the SRA nonreading test.

· Make checks payable to Basic Skills.
· Mail Registration by May 5, 2007
· Mail to: Janet Haddock, PO Box G, Pilot Rock, OR 97868


Testing Fees:
Testing total ($36/student)             $_________
Diagnostic Profile ($7/student)       $_________
                                           Total $_________

Please note: Extra copies of testing information and registration can be found at http://personal.my180.net/thesmiths/phsa.html