I-Excel Assessment on Thursday, June 6, 2019 at The Belin-Blank Center


Child's First Name:  

Child's Last Name:  


Date Of Birth:

Gender:  

Grade:  

Ethnicity:  

School (no need to select): 




Please note that both cell and day phone are required, but you may enter both as the same number if applicable (numbers only - that is, 1112223333 instead of (111) 222-3333).

Cell Phone:
Day Phone:

Home Address: 
City: 
State: 
Zip: 
Parent Email Address (please enter only one email address): 

Please read and check both boxes below:









This section is OPTIONAL.
My student took the Iowa Assessments:

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