Kindergarten-12th Grade Homeschool Application Form (one per family)

Family Last Name: *

Total number of K-12 students registering in your family: *

Student 1 Full Name (First, Middle, Last): *

Student 1 Grade Level: *

Student 2 Full Name (First, Middle, Last):

Student 2 Grade Level:

Student 3 Full Name (First, Middle, Last):

Student 3 Grade Level:

Student 4 Full Name (First, Middle, Last):

Student 4 Grade Level:

Student 5 Full Name (First, Middle, Last):

Student 5 Grade Level:

Student 6 Full Name (First, Middle, Last):

Student 6 Grade Level:

Student 7 Full Name (First, Middle, Last):

Student 7 Grade Level:

School County Zoned For (reporting): *

If new to FBA Umbrella, where should records be requested from (include email address)?

Primary Teaching Parent Name: *

Primary Contact Number: *

Does Primary Teaching Parent work outside the home? *

Yes No

Father’s Name: *

Father’s Occupation: *

Mother’s Name: *

Mother's Occupation: *

Are parents married to each other? *

Yes No

Is there any other person who is legally responsible for academic decisions? *

Yes No

If yes, please attach legal documentation here:

(allowed file types: jpg, pdf, png)

Is there any other person who will be responsible for teaching your child? *

Yes No

If yes, describe the arrangement:

Mailing Address: *

Address 1
Address 2

City

State

Zip

Church you attend faithfully/regularly: *

Are you a member, regular attender, or other? *

How long have you been at this church? *

Have you homeschooled before? *

Yes No

If so, how long have you homeschooled?

Why have you decided to homeschool? (Please list any and all reasons to help me best serve you). *

Any medical/educational needs/diagnoses that will help us know how to best serve your family?

Will you need standardized testing accommodations for any of your children? *

I have truthfully completed the application information to the best of my knowledge. *

Yes No

I agree with the FBA Statement of Faith (located under the Homeschool Registration Tab). *

Yes No

I understand that at least 180 days of school must be attended, with a minimum of 4 hours a day. *

Yes No

How did you hear about our Umbrella program? *

Enter Your Email Address: *