top of page

5a93704e-95d8-4acf-96df-1579c4b43707_edi

Home
About
Services
Contact Us

Getting answers starts here...

We sincerely appreciate your interest in Shine Bright Florida and commend you for taking the next step in supporting your child's development. Kindly complete the form below and we will promptly contact you to arrange your Initial Consult meeting. In this meeting, we will get to know your child's story, review our assessment and screening options, and schedule a time for them to complete the holistic asessment.

Child's name*

Birthday*

Month

Day

Year

School*

Current Grade*

Teacher's Name*

Parent/Guardian Name*

Phone*

Email*

Preferred Method of Contact*

Parent/Guardian Name

Phone*

Preferred Method of Contact

Emergency Contact Name*

Relation to Student

Phone*

1. Tell us about your child. What brings them the most joy? What are their favorite hobbies or activities?*

2. What are our child's greatest strengths?*

Reading

Math

Science

Creativity

Verbal Expression

Problem Solving

Athletics or Motor Skills

Social Interactions

Artistic Talent

Musical Ability

Other

If other, please state here:

3. Which areas does your child struggle or need support?

Reading comprehension

Spelling or writing

Math concepts

Attention or focus

Following directions

Managing emotions

Social skills

Transitions

Coordination

Speech or language

Other

If other, please state here:

4. Has your child been evaluated for any concerns?

Yes

If yes, please describe below:

5. What goals do you have for your child's growth?

Build confidence

Improve grades

Strengthen skills

Develop SEL (Social-emotional learning)

Understanding learning style

At-home support

Custom learning plan

On-campus tutoring

Other

If other, please describe below:

6. Please add any additional information you would like us to know:

7. Supporting documents: Please bring or upload documents that may help us during the initial consultation, such as previous test results, diagnosis/evaluations, teacher notes, report cards, or any additional documentation that will help guide our time.

8. Upload a current picture of child (not required)- we would love to put a face to your child's name and add it to their Personal Education Plan.

We will review this information and contact you to set up an initial consultation. We look forward to partnering with you and your child to empower them to shine their brightest!

Shine Bright Florida is proud to be a

Step Up for Students Provider

bottom of page