Homeschool Enrollment Form

Created for Shanti Karthik by Nhan Nguyen on 12/4/2020 and modified for Elise Locke on 04/08/2022
Homeschool Enrollment Form

This form is to be completed by parents/guardians and pertains only to residents of the State of Indiana.

Please verify your responses before clicking the submit button. You will be able to make changes after submitting homeschool enrollment report form using the hyperlink in your confirmation email.

If you have any questions, please contact: studentpathways_homeschool@doe.in.gov
By choosing to homeschool my child(ren), I understand that, as the parent/guardian.
1. Registration Date

MonthDayYear
DateHourMinutesAM/PM Option
2. Email

Confirmation Emailexample@example.com
3. Primary Parent/Guardian

First NameLast Name
4. If your child would attend public school, in what county is this school located?
5. In what public school corporation do you live?
6. Parent/Guardian Indiana Mailing Address

Street Address

Street Address Line 2

CityINDIANA (should be INDIANA)

Zip Code
7. Parent/Guardian Phone Number
Format: (000) 000-0000.
Participating Students in Each Grade Level (PK, KG, 1 to 12): Student Information First Name, Last Name, Current Grade and Date of Birth are required
Student Information
8. How many students in your homeschool?
8-1-a. 1st Student Name

First Name *Middle Name (optional)Last Name *
8-1-b. 1st Student Date of Birth

MonthDayYear
Date
8-1-c. 1st Student Current Grade
8-2-a. 2nd Student Name

First Name *Middle Name (optional)Last Name *
8-2-b. 2nd Student Date of Birth

MonthDayYear
Date
8-2-c. 2nd Student Current Grade
8-3-a. 3rd Student Name

First Name *Middle Name (optional)Last Name *
8-3-b. 3rd Student Date of Birth

MonthDayYear
Date
8-3-c. 3rd Student Current Grade
8-4-a. 4th Student Name

First Name *Middle Name (optional)Last Name *
8-4-b. 4th Student Date of Birth

MonthDayYear
Date
8-4-c. 4th Student Current Grade
8-5-a. 5th Student Name

First Name *Middle Name (optional)Last Name *
8-5-b. 5th Student Date of Birth

MonthDayYear
Date
8-5-c. 5th Student Current Grade
8-6-a. 6th Student Name

First Name *Middle Name (optional)Last Name *
8-6-b. 6th Student Date of Birth

MonthDayYear
Date
8-6-c. 6th Student Current Grade
8-7-a. 7th Student Name

First Name *Middle Name (optional)Last Name *
8-7-b. 7th Student Date of Birth

MonthDayYear
Date
8-7-c. 7th Student Current Grade
8-8-a. 8th Student Name

First Name *Middle Name (optional)Last Name *
8-8-b. 8th Student Date of Birth

MonthDayYear
Date
8-8-c. 8th Student Current Grade
8-9-a. 9th Student Name

First Name *Middle Name (optional)Last Name *
8-9-b. 9th Student Date of Birth

MonthDayYear
Date
8-9-c. 9th Student Current Grade
8-10-a. 10th Student Name

First Name *Middle Name (optional)Last Name *
8-10-b. 10th Student Date of Birth

MonthDayYear
Date
8-10-c. 10th Student Current Grade
Should be Empty: