Charlotte Mason NorCal
New Member Registration and Survey
Member Details:
Full Name
*
First Name
Last Name
Zip Code
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
E-mail
*
example@example.com
Age of children (years old), at present:
0-2
3-5
6-9
10-12
13-15
16-17
18+
Questionnaire:
How would you describe your homeschool? (select one)
*
Charlotte Mason
Classical Charlotte Mason
Charlotte Mason-Inspired
Classical
Eclectic
Not Currently Charlotte Mason
Not Currently Homeschooling
Other
What Charlotte Mason concepts would you like to learn more about in community? (select as many as apply)
*
What specific areas of study would you like to learn more about in community? (select as many as apply)
*
What aspect of Charlotte Mason's philosophy is most difficult to grasp in concept or to apply in a practical sense?:
Do you belong to a local Charlotte Mason co-op and/or reading group
Please Select
Yes
No
If yes, what type of things to you do together?:
Do you lead in your group?
Please Select
Yes
No
If yes, what do you lead?:
Do you think your group would be interested in hosting a regional Charlotte Mason event?
Please Select
Yes
No
Would you be willing to travel to a Charlotte Mason workshop, retreat, or conference within Northern California?
*
Please Select
Yes
No
What would influence your decision? (Select order that applies to you)
Please describe any other factors that may influence your decision.
How do you currently nurture your ongoing self-education of Charlotte Mason's philosophy of education?
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