Date hours were Submitted:

Father's Name: Mother's Name:

Last Name:

Address: City: State: Zip:

Phone: E-mail:

Student 1 full name: Birthday:

Student 2 full name: Birthday:

Student 3 full name: Birthday:

Student 4 full name: Birthday:

Student 5 full name: Birthday:

Student 6 full name: Birthday:

Are you planning to homeschool or supplement your homeschool using a publicly-funded program this year (eg. HOPE, COVA, etc.), excluding extracurricular or intramural activities such as sports or band?

Yes No

If yes, please specify the program:

Parents Responsibility to CHEC Independent School:

1. To maintain an attendance calendar demonstrating 172 days in school with an average of 4 hours per day, and to submit that calendar to CHEC Independent School at the end of the school year.

2. To provide test results (or test through the CHEC Independent School) using a nationally standardized test for each student in the 3rd, 5th, 7th, 9th, and 11th grades.

3. To provide CHEC with an updated immunization record for each student or a statement of exemption.

4. To pay CHEC annual enrollment fee prior to September 1st for each subsequent school year. Enrollment will automatically lapse if this renewal fee is not received or if the required information is not supplied in a timely manner.

Parents' Responsibility for the Instruction Program

1. To provide a sequential program of instruction to each student enrolled in the satellite school as a homeschooled student, and maintain contact hours of 172 days minimum with an average of 4 hours per day. This program of instruction will include communication skills of reading, writing, and speaking; mathematics, history, civics, literature, and science, and beginning no later than the 7th grade and continuing through high school, regular courses of instruction in the Constitution of the United States. This does not mean that every subject must be covered every year.

2. To test students using a nationally standardized test in grades 3, 5, 7, 9 11.

CHEC Independent School's Responsibilities to the Enrolled Family

1. To maintain the students' attendance records, test results, immunization records, and enrollment forms.

2. To provide phone support for each homeschool family registered with the program.

3. To provide other fee-based services such as introductory seminars, curriculum selection, testing, graduation ceremonies, and other support services for the homeschool.

4. CHEC reserves the right to dis-enroll a student if the school has reason to believe that the above noted obligations are not met.

1. Who will be overseeing the homeschooling of the children on this application (e.g. Father, Mother, or Both)?

2. Have any of the children on this application been expelled or suspended by a school, or are they currently involved in any court cases or social services proceedings? Yes No
If yes, please explain:

3. If signer is legal guardian of child, please explain relationship.

By clicking this box, I verify that all information on this application is true and correct, and understand and will adhere to the conditions and responsiblities aforementioned.

Please note, the enrollment fee is non-refundable.

$50 for re-up $145 for complete starter package