Green Dome Project Interest Form

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Email *

Prospective Student's Full Name & Nickname: *

Child's Date of Birth: *

YYYY

Child's current grade in school: *

Please tell us about your child. Be sure to tell us about some of strengths, interests, challenges, areas for growth, and any medical or health diagnoses that have impacted your child's learning. *

Please tell us about your family's educational philosophy.

What have your child's educational experiences been thus far? How would you rate his/ her proficiency in math, reading and writing?

How does your child handle frustration during a challenge? What are some of his or her strategies in persevering through a task or new learning?

Please tell us about the goals you have for your child as he / she joins The Green Dome Project. *

Please tell us about you, and any other caregiver, who will be involved with your child's school experience. Tell us about your interests & skills that you might like to offer the group. *

Please share any additional information you feel may be relevant to how we can best serve your child out here.

Please list your child's allergies or medical conditions, if any. *

Primary Parent Name/ Guardian Contact Info: email, cellphone, work phone (please specify) *

Parent / Guardian Contact Info: email, cellphone, work phone (please specify) *

How did you learn about us?

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