GPA Interest Survey
Our enrichment center PMA is strengthened by family and community involvement, and children feel nurtured as a result. We are a homeschool partnership providing families with enrichment programs for their children.
Parent 1 Name
First Name
Last Name
Parent 2 Name
First Name
Last Name
Parent 1 Email
example@example.com
Parent 2 Email
example@example.com
Parent 1 Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
How many children are you homeschooling?
Parent 2 Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Child 1 Name
First Name
Last Name
Child 1 Birth Date
-
Month
-
Day
Year
Date
Child 1 Grade
Is your child currently part of any cooperative enrichment program?
Please Select
Yes
No
Does your child have an IEP?
Please Select
Yes
No
If yes, do they need any special accommodations? Please list.
What favorite subjects or interests does your child have?
Please list any other subjects you would like to see explored.
Does your child have any allergies? List here
Child 2 Name
First Name
Last Name
Child 2 Birth Date
-
Month
-
Day
Year
Date
Child 2 Grade
Is child currently part of any cooperative enrichment program?
Please Select
Yes
No
Does child have an IEP?
Please Select
Yes
No
If yes, do they need any special accommodations? Please list.
What favorite subjects or interests does your child have?
Please list of any other subjects you would like to see explored.
Does your child have any allergies? List here
What homeschool curriculum have you used and how can our partnership help you?
How long have you homeschooled?
When are you interested in starting ?
What are you looking for in a partnership together? How can our enrichment center help you and/or your child(ren)?
How did you hear about us?
Submit
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