Learning Communities Student Application
Please complete the form below to participate in a Learning Community. Learning Communities are a service of Family Forum LLC.
Student Applicant First Name *
Please enter the student's first name.
Your answer
Student Applicant Last Name *
Please enter the student's last name.
Your answer
Student Applicant Email Address *
Please enter the student's email address.
Your answer
Student Applicant Birth Date *
Please enter the student's birth date. 2017-2018 Learning Communities are open to students born on or before August 31, 2005
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/
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/
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Student Gender *
Student Level *
Please select the student's level for the 2017-2018 school year.
Time Zone *
Please select the time zone in which the student resides:
Parent 1 First Name *
Please enter parent 1's first name.
Your answer
Parent 1 Last Name *
Please enter parent 1's last name.
Your answer
Parent 1 Email Address *
Please enter parent 1's email address.
Your answer
Parent 1 Phone Number *
Please enter parent 1's phone number.
Your answer
Parent 1 Physical Mailing Address *
Please enter parent 1's physical mailing address.
Your answer
Parent 2 First Name *
Please enter parent 2's first name
Your answer
Parent 2 Last Name *
Please enter parent 2's last name.
Your answer
Parent 2 Physical Mailing Address *
Please enter parent 2's physical mailing address, or indicate "same" if it is the same as parent 1.
Your answer
STUDENT Essay: Why do you want to be a part of a Learning Community? *
Please write 100–150 words.
Your answer
PARENT Essay: Why do you want your child to be in the Learning Communities program? *
Please write 100–150 words.
Your answer
Student Webinar Participation Agreement *
As a member of a Learning Community, I understand and agree to the following participation conditions.
Required
Student Course Participation Agreement *
As a Learning Community applicant, I understand and agree to the following participation conditions (please check all boxes below):
Required
Student Honor Code Agreement *
As a Learning Communities applicant, I understand and agree to the following student honor code agreement:
Required
Student Release Agreement *
I understand and agree to the following conditions and agreements for participation:
Required
Parent Release Agreement *
I understand and agree to the following conditions and agreements for participation:
Required
Information Release for Learning Community Directory (Optional)
I understand and agree to the following optional agreement:
Parent Finance Agreement *
I understand and agree to the following conditions and agreements for participation:
Required
Privacy Policy *
Please read and agree to our privacy policy. Please indicate your agreement by checking the box below.
Required
Parents: How can we best serve your education needs?
Parents: Please let us know about any considerations that you'd like our teachers and administrators to be aware of in serving the educational needs of your student.
Your answer
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