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Bald Eagle Assessments and Training Materials
   
  Please print clearly ...............          
 
DATE:      
  ATTN:            
  AGENCY:            
  ADDRESS:            
  CITY/STATE:         ZIP:  
  PHONE #            
               
Prices on this sheet are effective 1/1/2003 and replace all previously stated prices................................  
  Total  
         Item Description Quantity Price  
  Requested for Each Total
      Package of 10 $20.00   $2.00 $0.00
INDEPENDENT SKILLS ASSESSMENT Package of 25 $40.00   $1.60 $0.00
      Package of 50 $75.00   $1.50 $0.00
PERSONAL STRENGTHS AND NEEDS Package of 20 $10.00   $0.50 $0.00
      Package of 50 $20.00   $0.40 $0.00
ASSESSMENT OF CLINICAL NURSING NEEDS Package of 20 $10.00   $0.50 $0.00
      Package of 50 $20.00   $0.40 $0.00
ASSESSMENT OF NUTRITIONAL NEEDS   Package of 20 $10.00   $0.50 $0.00
      Package of 50 $20.00   $0.40 $0.00
SEXUALITY ASSESSMENT GUIDE + 20 worksheets + 18 black & white line drawings in binder   $20.00 $0.00
Worksheets must be used with a copy of the guide above Package of 20 $10.00   $0.50 $0.00
SEXUALITY ASSESSMENT WORKSHEETS Package of 50 $20.00   $0.40 $0.00
SEXUALITY KIT - Includes : 10 Sexuality Assessments, Guide Book with 18 line drawings,   $200.00 $0.00
anatomically correct dolls, artificial penis, sanitary pads & condom assortment, soft carry bag.      
Sample copy of any (or all) assessments listed above ($5.00) indicate by name:   $5.00 $0.00
Shipping Charges:   Minnesota Exempt Tax #   Subtotal $ $0.00
Orders up to $4.99 . . .  add $1.00         6.5% Tax Minn Only  
Order over $4.99 . . . . add 10% of subtotal cost     Shipping $ $0.00
Orders will be shipped fastest possible based on charges     TOTAL DUE $ $0.00
** It is requested that payment be included at the time of the order   SUBMIT ORDERS & PAYMENT TO:  
  ATTN: Janet Baldus  
FOR OFFICE USE ONLY           Bald Eagle Assessments
        111 11th Ave. N. E.  
Received Processed       Austin, MN  55912  
             
Billed Paid       www.baldeagle-assessments.com
      Telephone inquiries:  507-437-2074
wab: 5/96 Shipped     E-Mail:   info@baldeagle-assessments.com.