Prospective Students
Use this form to list students whom you would like to be enrolled in Homework House.
Note: if you would like to enroll more than 3 students, you only need to list the first 3 here.
Are your children enrolled in for free/reduced lunch? *
¿Califican sus hijos para almuerzo reducido/gratis?
Does your child attend a school in Azusa Unified School District? *
¿Asisten sus hijos a una escuela en el districto de Azusa?
Do you live in Azusa? *
¿Vive usted en Azusa?
Priority Schools
Please make sure the child goes to a school that is still open for enrollment.

Here are the schools that closed and/or require a referral from community liaison/principal:

ACCEPTING KIDS FROM ALL AUSD SCHOOLS

If child goes to closed school please use this wording:

"I'm sorry we have already reached our max capacity for _______ school. We are taking referrals for students from your school that have a need through the community liaison. She/He can be found in the school office. If you are interested, here are some other options for resources in our community: Azusa City Library tutoring (626-812-5232) and Shepherds Pantry in Glendora (626-852-7630)."

Now please stop filling out the form.
Parent Name *
Nombre del Padre
Your answer
Phone 1 *
Numero de telefono 1
Your answer
Primary Language *
¿Cual idioma se habla en la casa?
How did you hear about us? *
¿Como supo de nosotros?
Child 1
Hijo 1
Name *
Nombre
Your answer
School / Preschool Program
Escuela / Programa para pre-escolar
Grade
Grado
Child 2
Hijo 2
Name
Nombre
Your answer
School / Preschool Program
Escuela / Programa para pre-escolar
Grade
Grado
Child 3
Hijo 3
Name
Nombre
Your answer
School / Preschool Program
Escuela / Programa para pre-escolar
Grade
Grado
Early Childhood Program Information
Are you interested in enrolling a 3 or 4 year child into our School Readiness Program? *
Child's Birthdate
el cumpleaños de su hijo?
MM
/
DD
/
YYYY
Is the child potty-trained?
¿su hijo use el baño
Are you interested in being added to our interest form about a Mom's Support Group for parents of infants under 2? *
Child's Birthdate
el cumpleanos de su hijo?
MM
/
DD
/
YYYY
Additional Comments/Questions:
Other notes:
Your answer
Registration Dates:
Please check the Master calendar and let the called know of our next registration date. If there is none scheduled tell them we will call them when one has been scheduled which might not be till the next semester. Required items for registration: copies of report card, $25 per family (no check or bills over $20), doors shut after 5 mins, verification of free/reduced lunch.
I have informed caller of registration date. *
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