Order Form
Assessment Only: Elementary and Middle School Mathematics Courses
Please feel free to call with questions: (714) 619-7095
Please complete all fields; incomplete forms may delay processing.
K-12 pricing and order forms are only available for established public and private schools. Independent users can purchase ALEKS for individual use at
Ordering Instructions:
- Complete all contact information and check the subscription type desired. Provide multiple teacher names, email addresses, and course(s) to be taught, if necessary.
- Rename and save this form to your computer.
- Please submit your order inONEof the following ways to ALEKS Corporation:
E-mail: / Fax: (714) 242-6673
OR
Mail:Order Department, ALEKS Corporation
15460 Laguna Canyon Road
Irvine, CA 92618
School Contact Information: / Billing Information:District Name (if applicable): / Billing Institution, School, or District:
Institution/School: / Billing Address:
Range of All Grade Levels at This School: / BillingCity, BillingCounty:
Address: / Billing State/Province, Postal Code:
City, County: / Billing Country:
State/Province, Postal Code: / Billing Contact Name:
Country: / Billing Telephone #:
Contact Name: / Billing Alternative #:
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E-mail address:
Payment Options:Please enter a purchase order numberORenter credit card billing information.
Please note that all international orders must be prepaid.
10/26/2018
Purchase Order #:PRINT Cardholder Name:
Credit Card Information: (in lieu of purchase order) / Cardholder Billing Address:
Card Type:Please Choose a Credit CardAmerican ExpressVisaMasterCardDiscover / BillingCity, BillingCounty:
Card #: / Billing State/Province, Postal Code:
Expiration Date: / Billing Country:
Security No.*: / Authorization Signature:
*Security Numbers for VISA and MC are the last 3 digits of a number printed on the back of the card above the signature box.
The Security Number for AMEX is a 4-digit number printed on the front of the card to the right and above the card number.
Please complete the following required fields.
For Assessment Only, there is a 100 student subscription minimum.
10/26/2018
AssessmentOnly($5.00/student)TOTAL # of AssessmentOnly Student Subscriptions:
MS RtI Screening Assessment
Each MS RtI Screening Assessment includes one screening assessment per student. This is designed to assist administrators in placing students into the most optimal ALEKS RtI course products. There is a 100 subscription minimum when ordering or reordering MS RtI Screening Assessments.
MS RtI Screening Assessment ($10.00/student)-100 Subscription Minimum -
TOTAL # of Screening Assessment Subscriptions:
Please enter the contact information for the teachers who will be using ALEKS.
Title / Teacher’s Full Name / Email Address /Class
Grade Level / ALEKS Course(s)
Select:Dr.MissMr.Mrs.Ms.Prof. / Select:3rd4th5th6th7th8th9th10th11th12th / Select a Course:Elementary School Courses (all)Middle School Courses (all)Mathematics - LV 3 (with QuickTables)Mathematics - LV 4 (with QuickTables)Mathematics - LV 5 (with QuickTables)Mathematics - MS/LV 6Arithmetic (with QuickTables)Middle School Math Course 1Middle School Math Course 2Middle School Math Course 3Algebra ReadinessPre-AlgebraAlgebra 1CA Algebra 1Algebra 1 -- CoreEssential Mathematics (with QuickTables)RtI 6RtI 7RtI 8MS RtI Tier 3MS RtI Screening AssessmentOther - Use comments field
Select:Dr.MissMr.Mrs.Ms.Prof. / Select:3rd4th5th6th7th8th9th10th11th12th / Select a Course:Elementary School Courses (all)Middle School Courses (all)Mathematics - LV 3 (with QuickTables)Mathematics - LV 4 (with QuickTables)Mathematics - LV 5 (with QuickTables)Mathematics - MS/LV 6Arithmetic (with QuickTables)Middle School Math Course 1Middle School Math Course 2Middle School Math Course 3Algebra ReadinessPre-AlgebraAlgebra 1CA Algebra 1Algebra 1 -- CoreEssential Mathematics (with QuickTables)RtI 6RtI 7RtI 8MS RtI Tier 3MS RtI Screening AssessmentOther - Use comments field
Select:Dr.MissMr.Mrs.Ms.Prof. / Select:3rd4th5th6th7th8th9th10th11th12th / Select a Course:Elementary School Courses (all)Middle School Courses (all)Mathematics - LV 3 (with QuickTables)Mathematics - LV 4 (with QuickTables)Mathematics - LV 5 (with QuickTables)Mathematics - MS/LV 6Arithmetic (with QuickTables)Middle School Math Course 1Middle School Math Course 2Middle School Math Course 3Algebra ReadinessPre-AlgebraAlgebra 1CA Algebra 1Algebra 1 -- CoreEssential Mathematics (with QuickTables)RtI 6RtI 7RtI 8MS RtI Tier 3MS RtI Screening AssessmentOther - Use comments field
Select:Dr.MissMr.Mrs.Ms.Prof. / Select:3rd4th5th6th7th8th9th10th11th12th / Select a Course:Elementary School Courses (all)Middle School Courses (all)Mathematics - LV 3 (with QuickTables)Mathematics - LV 4 (with QuickTables)Mathematics - LV 5 (with QuickTables)Mathematics - MS/LV 6Arithmetic (with QuickTables)Middle School Math Course 1Middle School Math Course 2Middle School Math Course 3Algebra ReadinessPre-AlgebraAlgebra 1CA Algebra 1Algebra 1 -- CoreEssential Mathematics (with QuickTables)RtI 6RtI 7RtI 8MS RtI Tier 3MS RtI Screening AssessmentOther - Use comments field
Select:Dr.MissMr.Mrs.Ms.Prof. / Select:3rd4th5th6th7th8th9th10th11th12th / Select a Course:Elementary School Courses (all)Middle School Courses (all)Mathematics - LV 3 (with QuickTables)Mathematics - LV 4 (with QuickTables)Mathematics - LV 5 (with QuickTables)Mathematics - MS/LV 6Arithmetic (with QuickTables)Middle School Math Course 1Middle School Math Course 2Middle School Math Course 3Algebra ReadinessPre-AlgebraAlgebra 1CA Algebra 1Algebra 1 -- CoreEssential Mathematics (with QuickTables)RtI 6RtI 7RtI 8MS RtI Tier 3MS RtI Screening AssessmentOther - Use comments field
Select:Dr.MissMr.Mrs.Ms.Prof. / Select:3rd4th5th6th7th8th9th10th11th12th / Select a Course:Elementary School Courses (all)Middle School Courses (all)Mathematics - LV 3 (with QuickTables)Mathematics - LV 4 (with QuickTables)Mathematics - LV 5 (with QuickTables)Mathematics - MS/LV 6Arithmetic (with QuickTables)Middle School Math Course 1Middle School Math Course 2Middle School Math Course 3Algebra ReadinessPre-AlgebraAlgebra 1CA Algebra 1Algebra 1 -- CoreEssential Mathematics (with QuickTables)RtI 6RtI 7RtI 8MS RtI Tier 3MS RtI Screening AssessmentOther - Use comments field
Select:Dr.MissMr.Mrs.Ms.Prof. / Select:3rd4th5th6th7th8th9th10th11th12th / Select a Course:Elementary School Courses (all)Middle School Courses (all)Mathematics - LV 3 (with QuickTables)Mathematics - LV 4 (with QuickTables)Mathematics - LV 5 (with QuickTables)Mathematics - MS/LV 6Arithmetic (with QuickTables)Middle School Math Course 1Middle School Math Course 2Middle School Math Course 3Algebra ReadinessPre-AlgebraAlgebra 1CA Algebra 1Algebra 1 -- CoreEssential Mathematics (with QuickTables)RtI 6RtI 7RtI 8MS RtI Tier 3MS RtI Screening AssessmentOther - Use comments field
Select:Dr.MissMr.Mrs.Ms.Prof. / Select:3rd4th5th6th7th8th9th10th11th12th / Select a Course:Elementary School Courses (all)Middle School Courses (all)Mathematics - LV 3 (with QuickTables)Mathematics - LV 4 (with QuickTables)Mathematics - LV 5 (with QuickTables)Mathematics - MS/LV 6Arithmetic (with QuickTables)Middle School Math Course 1Middle School Math Course 2Middle School Math Course 3Algebra ReadinessPre-AlgebraAlgebra 1CA Algebra 1Algebra 1 -- CoreEssential Mathematics (with QuickTables)RtI 6RtI 7RtI 8MS RtI Tier 3MS RtI Screening AssessmentOther - Use comments field
Select:Dr.MissMr.Mrs.Ms.Prof. / Select:3rd4th5th6th7th8th9th10th11th12th / Select a Course:Elementary School Courses (all)Middle School Courses (all)Mathematics - LV 3 (with QuickTables)Mathematics - LV 4 (with QuickTables)Mathematics - LV 5 (with QuickTables)Mathematics - MS/LV 6Arithmetic (with QuickTables)Middle School Math Course 1Middle School Math Course 2Middle School Math Course 3Algebra ReadinessPre-AlgebraAlgebra 1CA Algebra 1Algebra 1 -- CoreEssential Mathematics (with QuickTables)RtI 6RtI 7RtI 8MS RtI Tier 3MS RtI Screening AssessmentOther - Use comments field
Select:Dr.MissMr.Mrs.Ms.Prof. / Select:3rd4th5th6th7th8th9th10th11th12th / Select a Course:Elementary School Courses (all)Middle School Courses (all)Mathematics - LV 3 (with QuickTables)Mathematics - LV 4 (with QuickTables)Mathematics - LV 5 (with QuickTables)Mathematics - MS/LV 6Arithmetic (with QuickTables)Middle School Math Course 1Middle School Math Course 2Middle School Math Course 3Algebra ReadinessPre-AlgebraAlgebra 1CA Algebra 1Algebra 1 -- CoreEssential Mathematics (with QuickTables)RtI 6RtI 7RtI 8MS RtI Tier 3MS RtI Screening AssessmentOther - Use comments field
Additional Comments:
Upon receipt of your order, you will receive a confirmation from ALEKS. If you do not receive a confirmation, please contact ALEKS at(714) 619-7095.Upon processing of your order,your subscription information will be e-mailed to you. Turnaround time is approximately 3 to 5 business days.
NOTE: For detailed ALEKS course information, please visit:
10/26/2018