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Application
Please fill out an application for each learner
Parent/Guardian's First Name
(Required)
Parent/Guardian's Last Name
(Required)
Learner's First Name
(Required)
Learner's Last Name
(Required)
Learner's Date of Birth
(Required)
MM slash DD slash YYYY
First Day of Enrollment
(Required)
MM slash DD slash YYYY
Learner's Gender
Male
Female
Current School District
Primary Language Spoken in Home
Learner Lives with:
(Required)
One Parent/Legal Guadian
Both Parents/Legal Guardians
Other
Learner's T-Shirt Size
Number of Siblings
Please enter a number from
0
to
20
.
How did you hear about Odyssey FM
Has your child skipped or repeated any grades?
Yes
No
Has your child been dismissed, suspended (in or out of school), placed on probation, asked to withdraw, withdrawn with discipline pending, denied re-enrollment, or received other significant disciplinary action from school?
What would we need to know about your child to serve them well? For example, allergies, fears, developmental challenges, medical history, medications, or previous classroom behavioral challenges?
If your child has undergone any evaluations or assessments for academic, behavioral, social, or emotional needs, please list and explain.
If your child has ever needed extra support for academic or emotional needs (tutor, counselor, therapist, psychologist, or physician), please expand.
What about your child's current learning experience has been the most challenging? How have you dealt with it?
Have you read "Courage to Grow" by Laura Sandefer?
Yes
No
On a scale 1-5, how familiar are you with the Hero's Journey (1 = Not familiar; 5 = I'm 100% on board)
Please enter a number from
1
to
5
.
What do you expect from Odyssey FM for your child?
What are the top 3 skills you desire for your child to learn in their school environment?
What excites you about the Acton Academy model?
What challenges you the most about the Acton Academy model?
What do you dream of your child being able to do by the time he/she is 18 years old? (i.e. travel the world working as they go, attend a prestigious college, start their own business, etc. - it’s always interesting to learn what a parent is envisioning for the future of their child.)
How often do you expect to hear updates on your child’s progress from the school?
Daily
Weekly
Monthly
Quarterly
What is important to you:
that your child learns to read and do math early in their learning journey
that your child learns how to set goals and manage time
How familiar are you with online learning and the options available today?
Please enter a number from
1
to
5
.
On the spectrum of micromanager to laissez faire parenting, where do you fall?
Please enter a number from
1
to
5
.
Please share 3 limits/boundaries that your child has at home and explain how you enforce those boundaries.
Tell us about a time you had to step back and let your child make a mistake that was painful.
What responsibilities does your child have at home?
When it comes to education, how do you define success or failure for your child?
Tell us about a project or challenge your child has completed from start to finish on their own.
How do you know when your child has learned something?
What is your child most curious about?
Does your child learn more from:
Figuring things out alone
With your guidance/instruction
*Please have your child complete or tell you their answers to the questions in this section of the application*
I will have my child help
My child is not available to fill this out right now
What do you like to do during your free time when you are inside?
What do you like to do during your free time when you are outside?
What books or stories do you love? Why?
What is the hardest part of being a good friend?
What do you like to learn about? How do you like to learn?
What do you like best about yourself?
What would you like to change about your life?
What else is there you want us to know about you?
Awesome job! Now you can pass it back to the parent!
What questions do you have for us? Is there anything more you are hoping to learn?
Email
(Required)
This application was completed by:
(Required)
Consent
(Required)
I agree
I confirm that the information on this application has been completed accurately and truthfully to the best of my knowledge.
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