Become a Screening Affiliate Partner Sign Up Here! Become a Screening Affiliate Partner Form 3 School Name * School Address * Address 1 Address 2 City State/Province Zip/Postal Code Country School Phone Number * (###) ### #### Grade Levels Offered * Primary Contact Name * First Name Last Name Primary Contact Email * Primary Contact Phone Number * (###) ### #### Where would you like to conduct the training? * Your Facility C&B Location (San Clemente) Other List of people wanting to be trained (Name, Email Address, Phone Number). * How many kits would you like to purchase? (Cost per kit $150). * Will you allow other screeners (from other schools) to attend your training? * Yes No Maybe On average, how many students do you anticipate assessing each year? * Would you be open to being a C&B on site location? (Where we send other students from other locations to be tested at your site). * Yes No Maybe To ensure a smooth scheduling process, please provide five dates you are available for training. Chancy and Bruce will review these dates and assign a training date with a minimum notice of 2 to 4 weeks. Each training will take approximately 3-4 hours. * Training Pricing * First Trainee: $500 Each Additional Trainee: $250 (Max cost is $1500 for unlimited trainees) Screening Kit: $150 per kit (school needs a minimum of 1-2 kits to assess their students) Scoring and Results: 500 or Less Students Screened Annually: $50 per student for the assessment review and results. Over 500 Students Screened Annually: Price may fluctuate Annual Licensing Fee: Under 50 students: $100 51-100 Students: $200 101-200 Students: $300 201-400 Students: $400 401-1,000 Students: $500 1,001+ Students: $1,000 Please sign your name below to agree to the above pricing: Assessment Payment Options Option 1: C and B sends parents a payment link attached to their in-take forms for $50 which they are required to pay prior to completing their permission/feedback form. Option 2: Your school pays C and B $50 per student. With this option, the school is able to charge the parents any amount. C and B will invoice the school at the end of each month. Select your preferred method of payment: Option 1 Option 2 Thank you! We are fortunate to partner with the following Schools Plus 200 more schools! Become a Screening Affiliate Partner Today! Sign Up Here Become a Screening Affiliate Partner Form School Name * School Address * Address 1 Address 2 City State/Province Zip/Postal Code Country School Phone Number * (###) ### #### Grade Levels Offered * Primary Contact Name * First Name Last Name Primary Contact Email * Primary Contact Phone Number * (###) ### #### Where would you like to conduct the training? * Your Facility C&B Location (San Clemente) Other List of people wanting to be trained (Name, Email Address, Phone Number). * How many kits would you like to purchase? (Cost per kit $150). * Will you allow other screeners (from other schools) to attend your training? * Yes No Maybe On average, how many students do you anticipate assessing each year? * Would you be open to being a C&B on site location? (Where we send other students from other locations to be tested at your site). * Yes No Maybe To ensure a smooth scheduling process, please provide five dates you are available for training. Chancy and Bruce will review these dates and assign a training date with a minimum notice of 2 to 4 weeks. Each training will take approximately 3-4 hours. * Training Pricing * First Trainee: $500 Each Additional Trainee: $250 (Max cost is $1500 for unlimited trainees) Screening Kit: $150 per kit (school needs a minimum of 1-2 kits to assess their students) Scoring and Results: 500 or Less Students Screened Annually: $50 per student for the assessment review and results. Over 500 Students Screened Annually: Price may fluctuate Annual Licensing Fee: Under 50 students: $100 51-100 Students: $200 101-200 Students: $300 201-400 Students: $400 401-1,000 Students: $500 1,001+ Students: $1,000 Please sign your name below to agree to the above pricing: Assessment Payment Options Option 1: C and B sends parents a payment link attached to their in-take forms for $50 which they are required to pay prior to completing their permission/feedback form. Option 2: Your school pays C and B $50 per student. With this option, the school is able to charge the parents any amount. C and B will invoice the school at the end of each month. Select your preferred method of payment: Option 1 Option 2 Thank you!
