Application

Please complete the following information if you would like to receive this service offered to the home educators in Shoreline and neighboring districts.

Indicate your interest in participating in the Home Education Exchange program.

Yes, add my name to your list of interested participants.

Yes, I'm interested, but not ready to sign-up at this time.

Yes, I'm interested, but I want more information before I make a decision.

Are you planning to homeschool this year?

Yes No Undecided

What are the ages of the children you are homeschooling?

Have you ever participated in a district operated homeschool program?

Yes, presently Yes, but not presently No, never

What kind of computer system do you use at home?

Other:

Would you like to be placed on our current mailing list?

Yes No

How would you prefer to be contacted?

Enter your contact information below:

Name:

Mailing Address:

Street:

City: City

Phone: FAX:

email:

Comments:

check this box if you wish to be contacted.

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