Teen Learning Center
Name *

First
Last
Spouse's Name *

First
Last
Today's Date *

MM		/
DD		/
YYYY
Address *

Street Address

Address Line 2

City
State / Province / Region

Postal / Zip Code
Country
Phone Number *

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Email *
What homeschool support group are you currently a member of? *
How did you hear about TLC? *
How many years have you been homeschooling? *
What classes are you interested in for your students?
For High School level, please be specific. Rather than Math,specify Algebra II. Rather than science, specify Biology, etc. *
What classes are you willing/able to teach? Again, please be specific. *
Please note: Acceptance is largely based upon what instruction parents are willing and able to provide in the areas we need.
Are you willing to teach Middle School and/or High School? *
 Yes 
 No 
Did you and your children read our policies and are you and your children in complete agreement with TLC structure and policies? *
 Yes 
 No 
Policies are available to view on our website: www.teenlearningcenter.org
Are you willing to commit to teach a full year, both Fall and Spring semesters? *
 Yes 
 No 
Are you willing to attend all four periods? *
 Yes 
 No 
Are there any issues that would require special accommodations for your child? Examples: learning disabilities/ medical therapies/ behavioral issues *
 Yes 
 No 
Please explain:
Do you understand and accept the "Three Strikes and You're Out" policy? *
 Yes 
 No 
You may review the "Three Strikes and You're Out" policy on our website: www.teenlearningcenter.org
Are you willing to supervise and/or assist your child at home in making sure assignments are completed on time? *
 Yes 
 No 
Please list child's name, age, and grade as of Aug. 1st 2012 for each child who would be attending TLC. *
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