JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Steps Learning Program Application
Fill out this form to enroll in Steps Learning Center LLC- You can select the program interested in between Homeschool Support, Aftercare or Tutoring.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Parent Name
*
Your answer
Will you be interested in 1:1 Speech & Language services from a Direct Pay Provider in our
location.
Yes
No
I would like more information.
Student name
Your answer
Phone Number
*
Your answer
Preferred contact method:
*
Email
Phone
Text
Other:
Required
Age
Your answer
School Name
Your answer
Grade Level
Your answer
Learning Environment
Self-contained classroom
General Education Classroom with ESE Services (IEP)
General Education Classroom with Accommodations (504)
General Education Setting
Homeschool
Other:
Clear selection
Main Areas of Needs/ Concerns:
*
Independent Living Skills
Academic Skills
Social- Emotional Skills
Communication (Verbal or Non-verbal)
Other:
Required
Program Interested in:
*
Full Time Microschool [Monday- Friday 9:00AM-3:00PM]
Part- Time 2/days Microschool
Part- Time 3/days Microschool
Full Time Afterschool [Monday - Friday 2:00PM-5:30PM]
Part Time Afterschool [1-3 days options]
Virtual Tutoring
Required
Do you plan to use the SUFS FES-UA to cover monthly tuition costs?
Yes
No
I want more information
Other:
Would you like to schedule a tour?
*
Yes
No
Virtual Meeting
Other:
Send me a copy of my responses.
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of Steps Learning Center LLC.
Report Abuse
Forms
