Remote Administration Registration Form

For in-person administration, please see In-Person Registration

Desired tester:
Desired test:
Test date & time:  
Parent/guardian Name:
Parents' email:
Note: Please add to your Contacts to avoid emails going to Spam.
Parents' home phone:
Parents' cell phone:   Texting available?
Name of school:

Full mailing address including city and state:
Student 1
    Full Name: Male    Female   

Date of Birth: Grade:

Student 2

    Full Name: Male    Female   

Date of Birth: Grade:

Student 3

    Full Name: Male    Female  

Date of Birth: Grade:



Woodcock-Johnson IV (check Brief plus desired additions):
$60 Brief
+ $20 Written Language
+ $10 Phoneme-Grapheme Knowledge
+ $5 Oral Reading
+ $20 Reading Comprehension
+ $20 Academic Knowledge
+ $50 Broad Oral Language
+ $15 Phonetic Coding

Total: Please note amount.  The total will be confirmed and an invoice will be sent.

Certification: My printed name below certifies that I agree to the following:

Printed Name:
Submission indicates your consent to use of this information for test administration purposes.  See Privacy for more information.