Student Application
Please complete this form for each child seeking enrollment in the Second Plane Homeschool Collective.
Sign in to Google to save your progress. Learn more
Student Name *
Names of Parents *
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Student resides with *
School District of Residence *
Educational Background (schools attended or homeschool) *
Last grade completed *
If homeschooled previously, please list name and email/phone number of most recent evaluator.
Has the child ever been suspended or expelled from a school? *
If yes, please explain the situation.
Please list one person [non-relative] that can be contacted as a character reference. Name/Phone or Email *
Has the child been diagnosed with any syndromes or disorders that may affect his/her learning? (ie: ADD/ADHD, Dyslexia, Dysgraphia, Dyscalculia, ODD, Autism, OCD, Asperger's Syndrome) *
Does the child have any auditory/visual impairments or any speech/language issues which may affect his/her learning? *
Has the child ever had an IEP? If yes, what is the most recent date of review? *
Does the child have any physical handicaps or medical issues that a teacher would need to be aware of? If yes, please elaborate. *
Academic area the child experiences the most success *
Required
Academic area the child experiences the greatest frustration *
Required
Please list any hobbies, interests, special abilities, extracurricular activities in which the child participates: *
Any additional information that may be helpful:
Schedule Options [See website for tuition details] *
How do you prefer to pay for tuition?
Clear selection
I understand that I am required to commit to the entire school year with payments expected monthly or at the start of each semester or at the beginning of the school year. *
I understand that Katie Strohecker will be our homeschool evaluator for the 2024-2025 school year and provide a letter for us to submit to our respective school district at the completion of the year. *
Required
Signature *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms