Excel Center Children Survey

In order to best determine the amount of impact The Excel Center has on both a parent and child, we would like to collect some basic information over your Child(ren)'s school performance. This information will only be used internally by our data and research team and no individual results will be shared publicly.

1. Excel Center Location *This question is required.

2. First Name *This question is required.

3. Last Name *This question is required.

4. Date of Birth *This question is required. This question requires a valid date format of MM/DD/YYYY.

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6. Number of Children In Grades 4-12? *This question is required. This question requires a valid number format.

7. Child 1: First Name

7. Child 1: Last Name

7. Child 1: Date of Birth This question requires a valid date format of MM/DD/YYYY.

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7. Child 1: Current School Corporation (Example: IPS, etc.)

7. Child 1: Current School Name:

7. Child 1: Current Grade Level:

7. Child 1: Grade Level When Last Tested:

7. Child 1: English Test Score This question requires a valid number format.

7. Child 1: Math Test Score: This question requires a valid number format.

7. Child 2: First Name

7. Child 2: Last Name

7. Child 2: Date of Birth This question requires a valid date format of MM/DD/YYYY.

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7. Child 2: Current School Corporation (Example: IPS, etc.)

7. Child 2: Current School Name

7. Child 2: Current Grade Level

7. Child 2: Grade Level When Last Tested

7. Child 2: English Test Score This question requires a valid number format.

7. Child 2: Math Test Score This question requires a valid number format.

7. Child 3: First Name

7. Child 3: Last Name

7. Child 3: Date of Birth This question requires a valid date format of MM/DD/YYYY.

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7. Child 3: Current School Corporation (examples: IPS, etc.)

7. Child 3: Current School Name

7. Child 3: Current Grade Level

7. Child 3: Grade Level When Last Tested

7. Child 3: English Test Score

7. Child 3: Math Test Score

7. Child 4: First Name

7. Child 4: Last Name

7. Child 4: Date of Birth This question requires a valid date format of MM/DD/YYYY.

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7. Child 4: Current School Corporation (example: IPS, etc.)

7. Child 4: Current School Name

7. Child 4: Current Grade Level

7. Child 4: Grade Level When Last Tested

7. Child 4: English Test Score This question requires a valid number format.

7. Child 4: Math Test Score This question requires a valid number format.