SelfDesign Learning Community Waitlist

First name *

Last name *

Phone *

Do you currently have a child enrolled in SelfDesign? *

Yes

No

Email *

How many learners do you wish to enrol? *

What grades are they in? *

Kindergarten

Grade 1

Grade 2

Grade 3

Grade 4

Grade 5

Grade 6

Grade 7

Grade 8

Grade 9

Grade 10

Grade 11

Grade 12

Names and PENs of learners (if known) *

Where are you located? *

If you answered "Other", where do you live?

How did you hear about us? *

If you answered "Other", how did you hear about us?

Why do you want to join SelfDesign Learning Community? *

Have you applied to other online learning/home schooling programs? *

Yes

No

If yes, how many other online learning programs did you register with?

Have you ever had an IEP or received SE support in the past? *

Yes

No

Before you applied to our waitlist, did you: *

Read the information on our website

Follow us on social media

Watch one or more of our informative videos

Download one or more of our information packages

Talk to a family enrolled in SelfDesign Learning Community

None of the above

What types of resources and support are you hoping to receive from SelfDesign Learning Community? *

What do you most want to know about SelfDesign Learning Community prior to enrolling in our program? *

Is there anything else you would like to share with us?

I would like to receive future information regarding SelfDesign programs and resources for families and parents.