Diverse Interactive Learning

Homeschool Questionnaire

First Name *

Last Name *

Phone *

Email *

Have you homeschooled before? *

Yes

No

What is your current situation? *

My child left traditional school and now we want to homeschool.

My child left virtual school and now we want to homeschool.

I am homeschooling but need assistance with my program and/or organization.

I have been homeschooling but I am looking for a different program.

If you chose none of the above, please explain. *

What is the age or are the ages of the homeschooled children? *

What gender is the child or what gender(s) are the children? *

Does the child or do the children have special needs? *

Yes

No

How would you describe the child or children behaviors and moods throughout the day. *

Are you interested in homeschool evaluation services? *

Yes

No

If you answered yes to the question above, when would you like to start? *

Soon As Possible

One month from Now

Two or more months from Now

I have an online homeschool program where I provide all the online resources for the curriculum and the 1 to 1 teachers for each of your child’s core subjects. Would you be interested in learning more about my program? *

Yes

No

Once the questionnaire is completed, you can sign up for a free 20 minute phone consultation with us here https://diverseilearning.com/booking-calendar/ to verify that I understand everything completely before the official meeting or the paid emails are sent. *

I Understand.

By checking this box, I consent to receive transactional messages related to my account, orders, or services I have requested. These messages may include appointment reminders, order confirmations, and account notifications among others. Message frequency may vary. Message & Data rates may apply.Reply HELP for help or STOP to opt-out.

By checking this box, I consent to receive marketing and promotional messages, including special offers, discounts, new product updates among others. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt-out.

Click here to sign up for the free 20 Minute Consultation.