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CONSULTATION
Tell us about yourself and let's start a learning journey that will transform your life
Prior to our consultation, please complete this form so that we can better understand your individual needs and develop a program tailored to you.
Your Details
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First Name
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Last Name
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Email
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Mobile
Student Details
LEARNING CHALLENGES
Describe the student's learning challenges in detail and anything that may impact their learning or behaviour.
You should also include their strengths and areas or subjects they enjoy.
MEDICAL RECORDS
Please tell us of any relevant medical information to do with their learning or behaviour.
ED PSYCH REPORTS
If you have an Ed Psych Report please email this to
office@a1student.com
.
PROGRAM GOALS
Please tell us what you want to achieve from this program so we can help you achieve this and succeed.
Student 3
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First Name
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Last Name
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Date of Birth
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Select...
Male
Female
Other
Gender
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Left
Right
Dominant Hand
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Current / Previous School
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Yes
No
Do you have an Ed Psych Report?
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Describe the Student's learning challenges as well as their strengths
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Is there any
medical
information
that
could
affect
the
student
's
learning
or
behaviour?
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Where would you like to be in a year?
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What are your Program Goals
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Submit
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