- Therese Homeschool Enrichment - New Student Application

Student's Legal Name (First, Middle, Last)

Student's Date of Birth

Month

Day

Year

Student's Gender

Male

Female

Parent/Guardian #1 Name, Phone Number, and/or Email

Parent/Guardian #1 Primary Home Address

Parent/Guardian #2 Name, Phone Number, and/or Email (if applicable)

Parent/Guardian #2 Home Address (if different from Parent/Guardian #1)

Student Other Home Address (if different than above)

Please check the box that best corresponds with your student

Transfer from a public school in CO

Transfer from a public school in another state

Transfer from home-based education

Tell us about yourself...

*indicates required field