Hawai'i Interest Form - Venture Upward

Do you have any homeschool experience?*

No
Yes

How many years of homeschool experience do you have?

Parent Name*

First Last

Phone*

Email*

Student Name*

First Last

Student Grade level as of September 1, 2024*

Birthday*

Gender*

Male
Female

Is your student currently on an IEP?

No
Yes

IEP Categories

Does your student currently have a 504 plan?

No
Yes

Student 2

Add Another Student

Second Student Name*

First Last

Student Grade level as of September 1, 2024*

Birthday*

Gender*

Male
Female

Is your student currently on an IEP?

No
Yes

IEP Categories

Does this student currently have a 504 plan?

No
Yes

Student 3

Add Another Student

Third Student Name*

First Last

Student Grade level as of September 1, 2024*

Birthday*

Gender*

Male
Female

Is your student currently on an IEP?

No
Yes

IEP Categories

Does this student currently have a 504 plan?

No
Yes

Student 4

Add Another Student

Fourth Student Name*

First Last

Student Grade level as of September 1, 2024*

Birthday*

Gender*

Male
Female

Is your student currently on an IEP?

No
Yes

IEP Categories

Does this student currently have a 504 plan?

No
Yes

Student 5

Add Another Student

Fifth Student Name*

First Last

Student Grade level as of September 1, 2024*

Birthday*

Gender*

Male
Female

Is your student currently on an IEP?

No
Yes

IEP Categories

Does this student currently have a 504 plan?

No
Yes

Note: Only five students can apply at a time. If you have more students, please fill the application out a second time.

Physical Address*

Street Address Address Line 2 City State ZIP Code

Mailing Address

Same as Physical Address

How did you hear about us?*

Any additional comments or questions

Hawai’i Interest Form