In-Person or Live Online Homeschool Evaluation
Please fill out this form for each child in your family who needs a homeschool evaluation. Thank you! (If you have more than 1 child, you do not have to type in the same info on each form that you submit, such as Parent Name, Address, Phone, Email, etc. To save time, you could submit it on your first child's form and then type "same" on the rest of your children's forms.)
Sign in to Google to save your progress. Learn more
Email *
What type of Homeschool Evaluation do you want? *
Child's First Name *
Child's Last Name *
Child's Nickname (Optional)
Child's Grade Level *
Child's Age *
Child's Date of Birth *
MM
/
DD
/
YYYY
Name of County that you are Registered in *
Do you plan to continue homeschooling for the next school year? (This is just for my info, so that if you need help with how to transition back to "brick & mortar" school, I can help you with that, if needed.) *
Parent/Guardian Name *
Street Address *
City *
State *
Zip Code *
Phone *
Email Address *
Please briefly describe how you homeschool your child in each subject. List the names of any curriculum, websites, books, co-ops, etc. How would you best describe your homeschooling approach/style? *
If your child has any special needs that you would like to share with me, please feel free to tell me about them here. (Autism, Speech/Language, Dyslexia, ADHD, Hearing/Vision, etc. (This info will remain private.) If you are not aware of the scholarship for students with special needs (FES-UA) and want to learn more, please let me know here.)
Payment Amount *
If you want to use your child's scholarship to pay for services, please tell me if you are using EMA or the Legacy system. If Legacy, please type in your child's scholarship student ID number.
I would like to add-on the following services:
If you want to use your child's scholarship to pay for any add-on services, please tell me which service(s) and do not include the price, i.e. 30-minute consultation, rush service, etc.
Please let me know some preferences for days/times to schedule your evaluation appointment in the next 2 weeks. If you need rush service, please text me at 850-723-4151 to confirm if I can meet your needs.
If you want to meet in-person, where would you prefer to meet at?
Clear selection
What is the best way to reach you? When? *
When is your homeschool evaluation due by?
Do you give permission for me to email the evaluation form to your county's home education office and copy your email address on it when I send it? If you do not give permission, I will email or give you the form and you will need to send in the form yourself. *
If you have any questions/comments, please type them here.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms