Learning Pod Student Intake Form

Learning Pod Student Intake Form

Please fill out the form below.
Thank you so much for choosing Mrs. Holman's Classroom, LLC, (aka me!) for helping you on your homeschool journey!

Please fill out the form below. This will ensure that we are on the same page and that I have all the information I need to best serve you!

You will recieve an invoice following completetion of this form.
Basic Details
Parent Name*

First NameLast Name
Student's Name*

First NameLast Name
Birth Date

MonthDayYear
Student's Email*
example@example.com - will be used create access to Canvas LMS
Parent's Phone Number*
Parent's Email*
example@example.com
Parent Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Learning Pod Details

Please answer the following questions. If you have not chosen your curriculum or want assistance closing a curriculum, you may note that instead in each applicable field.
Please list the last level/grade of subject that your student last completed. *
Please write what math curriculum you would like to use. *
If you purchased online pdfs, please email them to hello@mrsholmansclassroom.com. If physical copies, please bring them to lessons.
Please list your chosen language arts curriculum.*
If you purchased online pdfs, please email them to hello@mrsholmansclassroom.com. If physical copies, please bring them to lessons.
Please list your chosen science curriculum, if applicable.
If you purchased online pdfs, please email them to hello@mrsholmansclassroom.com. If physical copies, please bring them to lessons.
Please list your chosen history curriculum, if applicable.
If you purchased online pdfs, please email them to hello@mrsholmansclassroom.com. If physical copies, please bring them to lessons.
Just to confirm, we will use the Good and the Beautiful Language Arts 7.*

YesNoOther
Is there anything about your student's past schooling or learning preferences/challenges that you would like me to know? *
What are your student's hobbies, favorite things, or subjects he/she is interested in? Does your student have a career field in mind?*
Please list any dates that you will be out of town/not do school/taking a break, etc. This will help me plan. Unless you state otherwise, we will take off the week of Thanksgiving and . (If you would like to meet the Monday of thanksgiving week and have some assignments the beginning of that week, we can do that also. Just specify below.) *
Scheduling

Please choose your desired tier of service.
Classes will meet two days a week, Monday and Thursday, from 10:30am - 2:30pm. There will be a lunch break, so please send your student with a lunch.

Located in Fayetteville, but if you live in the Siloam/Gentry area, I might be able to drive your student.

The tiers of service are as follows:
- Standard ($125/wk):
  - I provide weekly feedback on math and language arts assignments.
  - I help your student stay on track and provide more structured support.
  - I can provide curriclum suggestions if desired.
  - I may adjust pacing or expectations to fit your student’s progress.
  - A good fit for families who want regular oversight without full outsourcing.
- Premium ($175/wk):
  - I handle all grading, pacing, and progress monitoring for math, language arts, histroy, and science.
  - I sit down with you and can provide my full curriculum recommendations based on your family's unique needs if desired.
  - Access to online Canvas LMS "course" to house assignments.
  - Parents receive weekly updates and feedback.
  - Your teen gets full academic coaching and encouragement from me.
  - Your teen gets FREE access to my Pre-Algebra or Algebra 1 curriculum.
  - All you have to do is check in with your student at home!
  - Ideal for busy parents or teens who need accountability and coaching.
Please choose your desired tier of service:

Standard: $125/weekPremium: $175/week
Please have your student bring lunch, any school books, completed work, calculator, a pencil/pen, and notebook each day to "class." A list of other needed school supplies will be provided following the initial meeting.

You will be asked to sign and date the contract before the first week of school.

I look forward to working with you!
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Learning Pod Student Intake Form

Basic Details

Learning Pod Details

Scheduling