Idaho Application - Venture Upward

Parent Name*

First Last

Phone*

Email*

Student Name*

First Last

Student Grade level as of September 1, 2023*

Birthday*

Gender*

Male
Female

Is your student currently on an IEP?*

Yes
No

IEP Categories

Does your student currently have a 504 plan?*

Yes
No

If no, do you have any current concerns about your student's learning, behavior, physical, or emotional needs that you would like to discuss with a member of our special education team?

Add Another 2

Add Another Student

Second Student Name*

First Last

Student Grade level as of September 1, 2023*

Birthday*

Gender*

Male
Female

Is your student currently on an IEP?*

Yes
No

IEP Categories

Does your student currently have a 504 plan?*

Yes
No

If no, do you have any current concerns about your student's learning, behavior, physical, or emotional needs that you would like to discuss with a member of our special education team?

Add Another 3

Add Another Student

Third Student Name*

First Last

Student Grade level as of September 1, 2023*

Birthday*

Gender*

Male
Female

Is your student currently on an IEP?*

Yes
No

IEP Categories

Does your student currently have a 504 plan?*

Yes
No

If no, do you have any current concerns about your student's learning, behavior, physical, or emotional needs that you would like to discuss with a member of our special education team?

Add Another 4

Add Another Student

Fourth Student Name*

First Last

Student Grade level as of September 1, 2023*

Birthday*

Gender*

Male
Female

Is your student currently on an IEP?*

Yes
No

IEP Categories

Does your student currently have a 504 plan?*

Yes
No

If no, do you have any current concerns about your student's learning, behavior, physical, or emotional needs that you would like to discuss with a member of our special education team?

Add Another 5

Add Another Student

Fifth Student Name*

First Last

Student Grade level as of September 1, 2023*

Birthday*

Gender*

Male
Female

Is your student currently on an IEP?*

Yes
No

IEP Categories

Does your student currently have a 504 plan?*

Yes
No

If no, do you have any current concerns about your student's learning, behavior, physical, or emotional needs that you would like to discuss with a member of our special education team?

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

Emergency Contact Name*

Emergency Contact Phone*

Do you have any previous homeschooling experience?*

No
Yes

How many years have you been home educating?*

Additional Comments or Questions

How did you hear about us?*