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Begin your application process today!
Part I: Contact Information
Student First Name
Student Last Name
Parent/Guardian First Name
Parent/Guardian Last Name
Email
Address
City
State
Zip
-- Select --
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Phone
Part II: Student Information
Birth Date
-- Select --
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
-- Select --
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
-- Select --
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Grade Level (as of Sept 2008)
-- Select --
8th
9th
10th
11th
12th
Don't Know
Other
Current School Type
-- Select --
Homeschooled
In Private School
In Public School
Out of School
Is the student currently:
(For informational purposes only - does not determine enrollment)
None of These
On an IEP
On a 504 Plan
On an ESL plan
Suspended
Expelled
Homeschooled
Has the student ever been:
(For informational purposes only - does not determine enrollment)
None of These
On an IEP
On a 504 Plan
On an ESL plan
Suspended
Expelled
Homeschooled
Current resident school district
Current or last school attended
Is another student in your family already enrolled at Insight?
Yes
No
Feel free to provide any other useful information. (optional)
Part III: Background
Let us know a bit about why are you considering Insight School of California - LA:
(multiple answers permitted)
Have homeschooled before, want to continue high school
Desire to progress through coursework quickly
Pursuing career in athletics/arts
Cannot attend school due to physical condition or illness
Frequent travel or moving
Work schedule conflict
Dropped out, not currently attending school
Dissatisfied with local school
Child care, pregnancy, or other familiy care
Other
How did you hear about us?
-- Select --
Mail
Brochure
Email
News Story
Newspaper Ad
TV Ad
Radio Ad
Bus Ad
Movie Theater
Web Banner/Online Ad
Link From Another Site
Web Search
Referral
Word of Mouth
Community Organization
Event
Poster
Insight Tour Bus
Postcard
Other
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