Digital Learning Program Parent Interest Survey

DIGITAL LEARNING PROGRAM PARENT INTEREST SURVEY
 
DIGITAL LEARNING PROGRAM PARENT INTEREST SURVEY
Please click the link above if you are interested in having your child be a part of the digital learning program for the 2012-2013 school year.


Parent Last Name Please provide your last name in the box below.
Parent First Name Please provide your first name in the box below.
Student’s Full Name Please provide the suggested student’s full name in the box above. If you have multiple students to suggest, please submit one form per student.
Student Grade
Internet Access Do you have access to high-speed internet at home?
Program Model Please specify the suggested program model that would best meet the needs of your student.
Your Name:  
Your Email:  

To validate your submission, please type the answer to the following question:


  

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