Off Campus Inquiry Form

Off Campus Information Page      Off Campus Home

Welcome!  If you would like to place your student on the waiting list for the CKSD Off-Campus Program, please fill out the form below in as much detail as possible and one of our consultants will contact you for an interview when an opening occurs.  If you simply want more information, please write or call: Off Campus 360-662-1780

blue fields are required only if you desire to enroll more than one student

Date: Information Completed By:  Parent        Student
Student Information Name: Grade: Birth date:
Student Information Name: Grade: Birth date:
Student Information Name: Grade: Birth date:
Parent Information Parent's Name:         
  Home Phone:            Alternate Phone:
  E-mail Address:
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Resident School District

When was the student last in school, or where is the student attending .
Has the student ever been home schooled?  Yes  No
Does the student have an active IEP (Special Education)?  Yes  No 
Have they had an IEP in the past?  Yes    No

How did you learn about Off Campus?

  

Reasons for considering the Off Campus Program?

  
Secondary students
(7th - 12th)
 		 Are you interested in taking a few classes at your district assigned school?
 
Elementary students
(K - 8th)		 Would you like to participate in Enrichment classes (grade level classes taught on Wednesdays, emphasizing social contact and group academic skills) or would you prefer a weekly meeting?
 
 

Who is the adult responsible for the student's education?

  

Who will supervise the student at home during the day?

  

Is your interest in Off Campus related to discipline?  If so, explain:

  
Other information:  

Or call us at 360-662-1780

Return to Off Campus Information Page

03/01/2007

CKSD Off Campus
Revised: March 01, 2007.