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Payment Information Charge to: (See note above) Ship to: (if different from billing address) Name Position Organization Billing Address City State Zip Phone: ( ) Fax: ( ) Email address Name Position Organization Shipping Address City State Zip Phone: ( ) Fax: ( ) Email address 2017 Florida Special Part C - Department of Health Battelle Developmental Inventory, 2nd Edition Normative Update (BDI-2 NU) Order Form Please enclose a check, money order, or valid purchase order with all orders. Purchase Order enclosed. Number Check enclosed. Number Money Order enclosed. IMPORTANT NOTE FOR CREDIT CARD USERS: For your security, we can only accept credit card orders through our secure website, hmhco.com/HMHAssessment, or by phone at 800.323.9540. Customers wishing to remit payment by credit card will be contacted by HMH Customer Experience Support—Assessments once their order has been processed. Exempt from state sales tax. (Please attach copy of certificate) Cert. no. Cert. Expiration Date NOTE: Orders from first time purchasers require a completed Test Purchaser Qualification Form. Professional Credentials Choose One: Test Purchaser Qualification Form attached Licensed In (area): State License Expiration Date Member of professional organizations (Check all that apply.) ACA AERA AMA APA ASHA CEC NASP NCME Other Page 1 of 4 Florida Department of Education (Part C) Select your local agency: q ES01-Bay Area • ES01-Data Entry q ES02-North Central • ES02-Data Entry q ES03-Northeastern • ES03-Data Entry q ES04-North Dade • ES04-Data Entry q ES05-Western Panhandle • ES05-Data Entry q ES06-Central Florida • ES06-Data Entry q ES07-West Central • ES07-Data Entry q ES09-Treasure Coast • ES09-Data Entry q ES10-Gold Coast • ES10-Data Entry q ES51-Big Bend • ES51-Data Entry q ES52-Space Coast • ES52-Data Entry q ES53-Southwest Florida • ES53-Data Entry q ES54-Gulf Central • ES54-Data Entry q ES55-North Beaches • ES55-Data Entry q ES57-Southernmost Coast • ES57-Data Entry STATE OF FLORIDA | Early Steps hmhco.com • 800.323.9540 Prices are valid until December 31, 2017 and are subject to change without notice. Date ___ /___ /___

2017 Florida Special Part C - Department of Health … ES09-Treasure Coast • ES09-Data Entry q ES10-Gold Coast • ES10-Data Entry q ES51-Big Bend • ES51-Data Entry q ES52-Space

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Page 1: 2017 Florida Special Part C - Department of Health … ES09-Treasure Coast • ES09-Data Entry q ES10-Gold Coast • ES10-Data Entry q ES51-Big Bend • ES51-Data Entry q ES52-Space

Payment Information

Charge to: (See note above) Ship to: (if different from billing address)

Name

Position

Organization

Billing Address

City State Zip

Phone: ( ) Fax: ( )

Email address

Name

Position

Organization

Shipping Address

City State Zip

Phone: ( ) Fax: ( )

Email address

2017 Florida Special Part C - Department of Health Battelle Developmental Inventory, 2nd Edition Normative Update (BDI-2™ NU) Order Form

Please enclose a check, money order, or valid purchase order with all orders.

Purchase Order enclosed. Number

Check enclosed. Number

Money Order enclosed.

IMPORTANT NOTE FOR CREDIT CARD USERS: For your security, we can only accept credit card orders through our secure website, hmhco.com/HMHAssessment, or by phone at 800.323.9540. Customers wishing to remit payment by credit card will be contacted by HMH Customer Experience Support—Assessments once their order has been processed.

Exempt from state sales tax. (Please attach copy of certificate)

Cert. no.

Cert. Expiration Date

NOTE: Orders from first time purchasers require a completed Test Purchaser Qualification Form.

Professional Credentials

Choose One:

Test Purchaser Qualification Form attached

Licensed In (area): State

License Expiration Date

Member of professional organizations (Check all that apply.)

ACA AERA AMA APA ASHA CEC

NASP NCME Other

Page 1 of 4

Florida Department of Education (Part C) Select your local agency:

q ES01-Bay Area • ES01-Data Entry

q ES02-North Central • ES02-Data Entry

q ES03-Northeastern • ES03-Data Entry

q ES04-North Dade • ES04-Data Entry

q ES05-Western Panhandle • ES05-Data Entry

q ES06-Central Florida • ES06-Data Entry

q ES07-West Central • ES07-Data Entry

q ES09-Treasure Coast • ES09-Data Entry

q ES10-Gold Coast • ES10-Data Entry

q ES51-Big Bend • ES51-Data Entry

q ES52-Space Coast • ES52-Data Entry

q ES53-Southwest Florida • ES53-Data Entry

q ES54-Gulf Central • ES54-Data Entry

q ES55-North Beaches • ES55-Data Entry

q ES57-Southernmost Coast • ES57-Data Entry

STATE OF FLORIDA | Early Steps

hmhco.com • 800.323.9540hmhco.com • 800.323.9540hmhco.com • 800.323.9540hmhco.com • 800.323.9540Prices are valid until December 31, 2017 and are subject to change without notice.

Date ___ /___ /___

Page 2: 2017 Florida Special Part C - Department of Health … ES09-Treasure Coast • ES09-Data Entry q ES10-Gold Coast • ES10-Data Entry q ES51-Big Bend • ES51-Data Entry q ES52-Space

Page 2 of 4

2017 Florida Special Part C - Department of Education, Battelle Development Inventory, 2nd Edition Normative Update (BDI-2™ NU) Order Form, Continued

Paper Kit Options and MaterialsPaper Administration and Scoring by Hand or Electronic Scoring and Reporting using the Data Manager website.

EnglishBDI-2 NU Premium Kit 1654694 ____________ $1,386.65 $1,247.99 ______________ (Includes 5 Test Item Books, Examiner’s Manual, Stimulus Book, Set of Presentation Cards, 15 Complete Record Forms, 15 Normative Update Student Workbooks, the Screening Test Item Book with 30 Screening Test Record Forms, Set of Screening Presentation Cards, Screening Stimulus Book, the complete set of BDI-2 Manipulatives, and a blue canvas carrying case)

BDI-2 NU Standard Kit 1654679 ____________ $1,187.15 $1,068.43 ______________ (Includes 5 Test Item Books, Examiner’s Manual, Stimulus Book, Set of Presentation Cards, 15 Complete Record Forms, 15 Normative Update Student Workbooks, the complete set of BDI-2 Manipulatives, and a blue canvas carrying case)

BDI-2 NU Basic Kit 1654697 ____________ $716.70 $645.03 ______________ (Includes 5 Test Item Books, Examiner’s Manual, Stimulus Book, Set of Presentation Cards, 15 Complete Record Forms, 15 Normative Update Student Workbooks, and a blue canvas carrying case. Please note: this kit does not contain the manipulatives needed to administer the BDI-2. First time BDI-2 NU purchasers should not select this option.)

BDI-2 NU Screener and Manipulatives Kit 1654701 ____________ $438.85 $394.96 ______________ (Includes Screening Test Item Book with 30 Screening Test Record Forms, Set of Screening Presentation Cards, Screening Stimulus Book, the screener set of BDI-2 Manipulatives, and a blue canvas carrying case)

BDI-2 NU Upgrade Kit 1654705 ____________ $193.15 $173.83 ______________ (Includes the new BDI-2 NU Examiner’s Manual, which contains updated norming tables, studies and a Spanish User’s Guide, as well as a 15-form package of the new BDI-2 NU Paper Test Record Forms)

SpanishBDI-2 NU Premium Spanish Kit 1654696 ____________ $1,386.65 $1,247.99 ______________ (Includes 5 Spanish Test Item Books, Examiner’s Manual, Stimulus Book, Set of Presentation Cards, 15 Spanish Normative Update Complete Record Forms, 15 Normative Update Student Workbooks, the Screening Test Item Book with 30 Spanish Normative Update Screening Record Forms, Set of Screening Presentation Cards, Screening Stimulus Book, the complete set of BDI-2 Manipulatives, Spanish presentation cards and workbook pages needed to administer, and a blue canvas carrying case)

BDI-2 NU Standard Spanish Kit 1654691 ____________ $1,187.15 $1,068.43 ______________ (Includes 5 Spanish Test Item Books, Examiner’s Manual, Stimulus Book, Set of Presentation Cards, 15 Spanish Normative Update Complete Record Forms, 15 Normative Update Student Workbooks, the complete set of BDI-2 Manipulatives, Spanish presentation cards and workbook pages needed to administer, and a blue canvas carrying case)

BDI-2 NU Basic Spanish Kit 1654699 ____________ $716.70 $645.03 ______________ (Includes 5 Spanish Test Item Books, Examiner’s Manual, Stimulus Book, Set of Presentation Cards, 15 Spanish Complete Record Forms, 15 Normative Update Student Workbooks, Spanish presentation cards and workbook pages needed to administer, and a blue canvas carrying case. Please note: this kit does not contain the manipulatives needed to administer the BDI-2. First time BDI-2 NU purchasers should not select this option.)

BDI-2 NU Spanish Screener and Manipulatives Kit 1654703 ____________ $438.85 $394.96 ______________ (Includes the Screening Test Item Book with 30 Spanish Normative Update Screening Record Forms, Set of Screening Presentation Cards, Screening Stimulus Book, the screener set of BDI-2 Manipulatives, Spanish presentation cards and workbook pages needed to administer, and a blue canvas carrying case)

Subtotal for this page ______________

Continued, next page

Item and Packaging Code Number Quantity Catalog Price Discount Price Total Price

hmhco.com • 800.323.9540

Prices are valid until December 31, 2017 and are subject to change without notice.

Page 3: 2017 Florida Special Part C - Department of Health … ES09-Treasure Coast • ES09-Data Entry q ES10-Gold Coast • ES10-Data Entry q ES51-Big Bend • ES51-Data Entry q ES52-Space

Page 3 of 4

2017 Florida Special Part C - Department of Education, Battelle Development Inventory, 2nd Edition Normative Update (BDI-2™ NU) Order Form, Continued

hmhco.com • 800.323.9540

Data ManagerBDI-2 Data Manager Software Kit (Web) Single 1029586 ____________ $381.75 $343.57 ______________ Data Manager provides a secure environment where users can enter raw score information or item details from paper record forms and generate useful individual or group reports while eliminating scoring errors. Data Manager also allows state departments, districts and agencies to aggregate and export hierarchical data for federal and state reporting.

NOTE: Examiners have access to both BDI-2 and BDI-2 NU norms.

Additional ResourcesBDI-2 NU Complete Record Forms, Pkg. 15 1652637 ____________ $85.70 $77.13 ______________

BDI-2 NU Screener Test Record Forms, Pkg. 30 1652619 ____________ $99.85 $89.86 ______________

BDI-2 NU Spanish Complete Record Forms, Pkg. 15 1652620 ____________ $85.70 $77.13 ______________

BDI-2 NU Spanish Screener Test Record Forms, Pkg. 30 1652621 ____________ $99.85 $89.86 ______________

BDI-2 NU Student Workbooks, Pkg. 15 1655605 ____________ $85.70 $77.13 ______________

BDI-2 NU Examiner’s Manual 1652631 ____________ $108.55 $97.69 ______________

BDI-2 Carrying Case 924599 ____________ $92.20 $82.98 ______________

BDI-2 Complete Manipulatives Kit 924580 ____________ $662.05 $595.84 ______________ Contains over 75 items (including specialized manipulatives) used in the administration of the BDI-2 NU.

BDI-2 Specialized Manipulatives Kit 1050055 ____________ $322.50 $290.25 ______________ Includes over 40 unique or hard-to-find Manipulatives for the BDI-2 NU. Additional common items such as crayons, string, chalk, clay, etc. will need to be supplied by the examiner.

eKits and MaterialsElectronic Kits (eKits) allow examiners to enter item details directly into a MDS app license via an electronic record form. No paper record forms are needed since item responses are uploaded to the secure Data Manager website where full reporting options are available.

BDI-2 NU Complete eKit with Manipulatives & MDS* 1654707 ____________ $1,500.65 $1,350.58 ______________ (Includes Normative Update Examiner’s Manual, Stimulus Book, Set of Presentation Cards, 35 Electronic Record Forms, 15 Student Workbooks, Set of Screening Presentation Cards, Screening Stimulus Book, the complete set of BDI-2 Manipulatives, 1 Mobile Data Solution (MDS) license, Complete Mobile Data Solution software, and carrying case)

Have you already purchased the Data Manager Product? YES ___ NO____

BDI-2 NU Screener eKit with Manipulatives & MDS* 1655608 ____________ $515.00 $463.50 ______________ (Includes Examiner’s Manual, the Screening Test Item Book, 30 Electronic Record Forms set of Screening Presentation Cards, Screening Stimulus Book, Screening Test Quick Reference Guide, Manipulatives needed to administer the Screening Test, Screener Mobile Data Solution software, 1 Mobile Data Solution (MDS) license, and a canvas carrying case)

Have you already purchased the Data Manager Product? YES ___ NO____

*NOTE: Windows compatible. BDI-2 Mobile Data Solution (MDS) requires licensed access to BDI-2 Data Manager. Examiners have access to both BDI-2 and BDI-2 NU norms.

Subtotal for this page ______________

Continued, next page

Item and Packaging Code Number Quantity Catalog Price Discount Price Total Price

Prices are valid until December 31, 2017 and are subject to change without notice.

Page 4: 2017 Florida Special Part C - Department of Health … ES09-Treasure Coast • ES09-Data Entry q ES10-Gold Coast • ES10-Data Entry q ES51-Big Bend • ES51-Data Entry q ES52-Space

Page 4 of 4

2017 Florida Special Part C - Department of Education, Battelle Development Inventory, 2nd Edition Normative Update (BDI-2™ NU) Order Form, Continued

hmhco.com • 800.323.9540

eKits and Materials (continued)MDS Upgrade License** 1486934 ____________ $267.80 $241.02 ______________ One Mobile Data Solution (MDS) license that can be added to your Data Manager Account. License dornloaded from your Data Manager website account to your Windows device.

**NOTE: Manipulatives and Stimulus Materials are needed to administer the assessment. This item offered for customers who currently have a Complete BDI-2 or BDI-2 NU Kit.

BDI-2 NU Data Manager Web Electronic Record Forms ERFs)*** Pkg. 20 1652643 ____________ $82.10 $73.89 ______________

***NOTE: ERFs are electronic record forms used when purchasing an eKit. ERFs are only for use with BDI-2 eKits.

BDI-2™ is a trademark of Houghton Mifflin Harcourt Publishing Company. © Houghton Mifflin Harcourt Publishing Company. All rights reserved. Printed in the U.S.A. 12/14/16

Certain clinical assessments include manipulatives with small parts that may present a choking hazard for children under the age of eight. Do not allow the child to place any manipulative in their mouth. A trained adult examiner must always closely supervise the administration of clinical tests and the use of manipulatives by children.

* A shipping service fee is prepaid and added to the invoice. Estimate 10% ($10.00 minimum) for ground shipping; 15% ($10.00 minimum) for Second Day Air and shipping to AK and HI; 17% ($20.00 minimum) for Next Day Air shipping; and 25% for international shipments. Ground transportation available for AK and HI upon request.

Subtotal for this page ______________

Subtotal from previous pages ______________

Order Subtotal ______________

Coupon Code ______________

State Sales Tax ______________

Shipping Service Fee* ______________

Order Total ______________

Note: The HMH Quantity Discount does not apply to this offer.

Prices quoted are subject to change without notice and do not include transportation charges unless otherwise stated. All orders will be filled at prices in effect upon receipt of your order. To obtain the most up to date pricing please call

Houghton Mifflin Harcourt at 800.323.9540 or visit us online at hmhco.com.

Note: To insure adequate processing time when submitting an expedited RUSH order, please phone in your order to 800.323.9540.

10% Discount: Use code

RPCCL0R6PB

Expires 12/31/2017

Via email: [email protected]

Via fax: 630.467.7192

Via phone: 800.323.9540

How to Place Your Order:

Inquiries may be directed to: [email protected] For more information, please visit: hmhco.com/HMHAssessment

Via mail: Customer Experience Support—Assessments Houghton Mifflin Harcourt 255 38th Avenue, Suite L St. Charles, IL 60174

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Item and Packaging Code Number Quantity Catalog Price Discount Price Total Price