Main Site

ENROLLMENT FORM

Internet Home School
3060 Hozoni Rd.
Prescott, Arizona 86305

EXECUTE THE PRINT COMMAND WHILE THE INFORMATION BELOW IS STILL VISIBLE ON YOUR BROWSER. After printing a hardcopy of this form, use a dark colored pen or type your personal information in the spaces provided. Sign your name in the signature field and return to Internet Home School by mail or fax. Our fax number is (928) 708-9384 . Our mailing address is: Internet Home School, 3060 Hozoni Rd Prescott AZ 86305.

After we receive this enrollment form we will need to contact you by phone. Please indicate a number at which you can be reached and a good time to call.
Phone number__________________ Time to call CST ________________

Student's Legal Name:__________________________________________________
(Last, First, Middle)
Billing Address: ________________________________________________________
(R.R. - P.O.Box - Street)
________________________________________________________
(City, State, Zip)

Shipping Address: (Please Note that we can not deliver to a P.O. box) ________________________________________________________
(R.R. - Street)
________________________________________________________
(City, State, Zip)

Home Phone: ___________________ Cell Number ___________________

Social Security Number:________________________ Birth date:___________________

Birthplace:_____________ Sex: _________ Last Grade Completed:________________
Father's Name____________________
Parent's Social Security Number_____________________________
Employer:___________________________________ Work Phone:__________________
Can we contact you at work? yes _____ no ________

Mother's Name:__________________________________________________
Parent's Social Security Number__________________________________
Employer:___________________________________ Work Phone:__________________
Can we contact you at work? yes _____ no ________
Guardian's Name:__________________________________________________________
Employer:___________________________________ Work Phone:__________________
Guardian's Social Security Number
Additional Phone-Fax Number:________________________________________________

Why have you chosen to home school?__________________________________________

________________________________________________________________________
Required E-mail address (Parent)________________________________( This e mail should be secure and not accessible to the student)
E-mail address (student) _______________________________
Ethnic Data Please check the one that applies to you :

__ Asian or Pacific Islander __ Hispanic __ Native American/American Indian __ Black or Afro-American __ Caucasian/ White _________Other

Tuition and Fees

PLEASE SELECT ONE	Monthly Tuition (refundable within 5 calendar days)	Setup Fee (non-refundable)	1st Month Total
Grades 1-4
O Option 1*	$150.00	$100.00	$250.00
O Year in Advance	$1,800.00	$50.00	$1,850.00
O Option 2*	$250.00	$100.00	$350.00
O Year in Advance	$3,000.00	$50.00	$3,050.00
Grades 5-12
O Option 1*	$215.00	$100.00	$315.00
O Year in Advance	$2,580.00	$50.00	$2,630.00
O Option 2*	$315.00	$100.00	$415.00
O Year in Advance	$3,780.00	$50.00	$3,830.00
Summer School
O Option 1*	$100.00 (per course)	$30.00	$130.00 (for one course)
O Option 2*	$150.00 (per course)	$30.00	$180.00 (for one course)

* Option 1: the family is responsible for grading student work

* Option 2: IHS provides grading services

Both options include on-line certified teachers, curriculum guides, answer keys, an on-line grade book, report cards and transcripts.

Families that enroll 2 or more children: save $100.00 at time of enrollment .

Parents pay the expense of textbook shipment in the first monthly billing and thereafter when new materials are required. There is never a fee charged for the sale of any textbooks or other instructional materials you receive from IHS. The average price to ship a package containing 4-5 large books is between $15.00 to $30.00. Textbooks must be returned or you will be charged the actual cost for the textbooks.
*When you have completed the program the textbooks must be returned or you will be charged the actual charge for the textbooks.

Internet Home School Billing Policy
Parents are responsible for the set up fee and the first month tuition at the time of start up.30 day's after you sign up the monthly tuition will start automatically, (the monthly tuition of $215.00 or $315.00, depending on the Grading Option plan that you choose) . The monthly payment plan is an installment arrangement to off-set the annual tuition. Any E check that is returned or Credit card that is declined will be charged a $25.00 late fee. Parents pay the expense of textbook shipment when new materials are required and shipped. The average price for shipping of a package containing 4-5 large books is approximately $45.00 in the US and $150.00 internationally. The fee's for shipping are based on actual Fed Ex bills that IHS receives. We will be shipping express delivery unless you notify the office otherwise - Please allow approximately 3 days for textbook delivery inside the United States. The Internet Home School does not discriminate on the basis of race, sex, color, national origin, religion, creed, or disability. If you do not return the textbooks at the time of withdraw you will be charged the actual charge of the textbooks.
Withdrawal Policy
You must notify the office 30 day's in advance of withdrawing .

I have read and understood the policies regarding enrollment of my child in Internet Home School.

Signature of parent or guardian ______________________________________

IMPORTANT - PLEASE READ AND ANSWER THIS SECTION CAREFULLY:
SPECIAL NEEDS INFORMATION
1. Has your child ever been in Special Education? _____Yes _____No If yes, when?____________

2. Was your child in a Special Education Program at the last school attended? _____Yes _____No

Please mark and "X" by the program in which he/she participated:

___RSP (Resource Specialist Program) __EH/LDG __Physical Handicap ___SDC

(Special Day Class) __EMR __Gifted/Talented ___SED (Severely Emotionally Disturbed) __TMR

___504 (Special Services for Disabilities)

BRIEFLY DESCRIBE THE NATURE OF YOUR STUDENT'S SPECIAL NEEDS (ATTACH ADDITIONAL PAGES IF NECESSARY): ______________________________________________________________________

___________________________________________________________________________________

CUMULATIVE RECORDS RELEASE INFORMATION:

Name and Address of School Where Student's Accumulative Records are Held:

School or District Name______________________________________________________

Street Address______________________________________________________________

City______________________State______Zip/Postal Code_______________

Country___________ Voice Number ________________ Fax Number _______________

I (we) the undersigned, parent, parents, or legal guardians do hereby authorize and consent to the transfer of all permanent student records and individualized education plans held on my child, _____________________________________ , to the Internet Home School of Prescott, Arizona. I have read and understand my (our) responsibilities as a home school parent and do hereby agree to comply with those tenets.

Signature of Parent:________________________________________ Date:___________
or
Signature of Legal Guardian:_________________________________ Date:___________

Note: