La Porte Online School Interest Form

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Please complete this form if you are interested in applying to La Porte Online School. A member of La Porte Online School will contact you with further information and help you decide if virtual education is right for you.

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Email *

How did you hear about us? *

Student's Last Name *

Student's First Name *

Student's Birthdate *

AAAA

Student's Current Grade Level *

Name of School Currently Attending *

Relationship to Student *

Parent/Guardian Last Name *

Parent/Guardian First Name *

Parent/Guardian Contact Information: Phone *

Parent/Guardian Contact Information: Email *

Home Mailing Address: Number and Street (Example: 1234 Reading Avenue, Apt 203) *

Home Mailing Address: City, State (Example: La Porte, Indiana) *

Home Mailing Address: Zip Code *

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