Family Interest form

(Pre-Application)

Interested in joining our program? Fill out some info and we will be in touch!

Please check your Spam folder for a response.

Parent Name

First Name

Last Name

Parent Email

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent Phone

(###)

###

####

What programs are you interested in?

Enrichment

Core Support

Student #1 Name

Student #1 DOB

YYYY

Student #2 Name

Student #2 DOB

YYYY

What are your reasons for seeking a homeschool hybrid or enrichment program?

Describe your child’s personality, strengths, and challenges.

How does your family support social-emotional learning at home?

Have there been any previous concerns from educators about your child’s behavior or academics?

Has your child ever had difficulty with self-regulation, following directions, or conflict with peers in a group setting?

Does your child currently have any support plans (IEP, 504, therapy, accommodations)?

Can your child use the restroom fully independently?

Referred By

First Name

Last Name