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Life Homeschool Academy Interest Form
Please complete one form per student
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* Indicates required question
Email
*
Your email
Parent/Legal Guardian Name
*
Your answer
Address
*
Your answer
Mobile number
*
Your answer
Student's Full Name
*
Your answer
DOB
*
MM
/
DD
/
YYYY
Grade going into in fall of 2024
*
Your answer
Do you already have a Homeschool Affidavit for this student?
*
Yes
No
Are you already "ESA" approved
*
Yes
No
Comments
Your answer
A copy of your responses will be emailed to the address you provided.
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