Homeschool Mentorship Program Application

Homeschool Mentorship Program Application
Homeschool Mentorship Program Application
Fill out this form if you are a new homeschooling family and wish to be paired with a homeschool mentor. (By signing this document, you agree to adhere to all standard library policies and procedures.
New Homeschooler Checklist (Check each box you have completed)

Receive packet from library (containing records templates, laws, and sample Letter of Intent) Withdraw student from public school (if currently enrolled) Fill out the Letter of Intent to homeschool and submit (mail or hand delivered) it to your school board's Director of Pupil Personnel. Review the law and requirements in your packet
Letter of Intent Date of Submission

Month Day Year
Date
1. Full Name
2. Address
3. E-Mail Address
4. Phone Number
5. How would you describe your current level of interest in homeschooling?
6. Do you plan on having your child enrolled in public school?

Yes No
7. What kind of homeschooling experience do you prefer?

Faith-based curriculum and homeschooling community Secular curriculum and homeschooling community I prefer a combination of secular and faith-based resources No preference
8. Do you have internet at home or convenient access to internet? (The library has locations in both Olive Hill and Grayson with free Wi-Fi)

Yes No No, but I have access elsewhere or will make use of the library.
9. What curriculum form best suits your needs?

Fully online Mostly online, some textbooks/workbooks Half online, half in textbooks/workbooks Some online, mostly textbooks/workbooks Fully textbook/workbook Unsure
10. How many hours per week do you intend to spend with your child doing school activities?

Less than 10 Hours 10-20 Hours 20-30 Hours 30-40 Hours >40 Hours (Full-time homeschool instructor)
11. In a few words, please tell us why you decided to homeschool
12. What is your current level of education? (This question is to help us place you with a mentor and will only be seen by library staff and mentors.)

Highschool diploma or equivalent (i.e. GED) Associates Bachelors (i.e. BS, BA) Advanced graduate degree (i.e. Masters, Doctorate)
13. How many children do you have and what are their ages?
14. Do you have any children with special needs? (Autism, ADD/ADHD, dyslexia, etc)
15. Do you have anything to add?
16. Sign & Date

Clear
Should be Empty:

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