Parent Information
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Father's (Guardian's ) Last Name First Name
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Mother's (Guardian's ) Last Name First Name
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Street Address City State Postal Code
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Nation Phone (the one consultants will Email
call you on)
Learner Information
First Learner
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Middle |
Sex |
Birth Date |
Grade |
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Second Learner
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Middle |
Sex |
Birth Date |
Grade |
Email |
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Third Learner
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Middle |
Sex |
Birth Date |
Grade |
Email |
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Family Status
- Are both parents living at home?
- Are both parents supportive of pursuing an Independent Learning Program?
- Are both parents working?
- Who will be home during the day?
- Which adult will maintain primary responsibility for providing regular and thorough instruction of the student(s) and be the contact for conferences:
- Are you planning to return your child to a school in the next year or two?
- If you are transferring to TLCI from a school or another homeschool program, please state the reason:
_______________________________________________________________________
- What issues do you feel will be most challenging for your family as you adapt to an independent learning program?
- Is there any other information that is important for your consultant to know to better understand your situation in order to provide the best support and guidance?
Will any child under 15 be alone at home on a regular basis during the 9-5 workday? If YES, complete the “Home Alone Criteria” below.
HOME ALONE CRITERIA (15 and under)—Failure to provide adequate adult supervision may result in disenrollment from TLCI (no refund). The success of the independent learning program may be severely diminished when both parents work and the learner is consistently left unsupervised for more than FOUR HOURS during the 9-5 work day.
If this is the case, One or more of the following SOLUTIONS is REQUIRED to assure a successful homeschooling program.
- Accompanies parent to work site all/part of one or more days per week
- Volunteers at a supervised site several times a week (library, office, farm, etc.)
- Involved in a work-study program (works at a restaurant, building trade, office, etc)
- Receives supervised daily class/tutor/activity in or out of the home. • Other (Describe):
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