Virtual Saturdays Registration Form

Iaomai Advantage Virtual Saturdays Registration Form

Important: Submitting this form is your formal registration request. It does not guarantee a spot. We will review all applications carefully to ensure the cohort is a good fit for every participant. Approved families will receive a confirmation email with payment instructions to secure your child's place. Spots are filled on a first-approved, first-paid basis. Thank you for your understanding.
Parent's Name*

First NameLast Name
Parent's Email Address*
example@example.com
Parent's Phone Number
Please enter a valid phone number.
Student's Name*

First NameLast Name
Student's Birth Date*

MonthDayYear
Student's Gender*
Student's Current Grade*
Student's Email Address
example@example.com
Does your student have a diagnosed or suspected learning difference, disability, accommodation plan (such as an IEP or 504 Plan), or other support needs?
If yes or unsure, please provide a brief description of the learning difference, diagnosis, or accommodation needs:
What specific challenges does your student face in reading comprehension, writing, or grammar/sentence structure?
What are your main goals for your student in this program?
How did you hear about this program?
I understand this is a formal registration request for the closed-cohort pilot program. Submission does not guarantee acceptance. I agree to be contacted via email/phone for review, approval status, and payment instructions if approved. I confirm all information provided is accurate.

Yes
Should be Empty:

Iaomai Advantage Virtual Saturdays Registration Form