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Parent/Guardian Information
First Name
*
Last Name
*
Email
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Contact Info
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City
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State
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ZIP
*
Phone
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Questions
Where you heard about ECOT:
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ECOT Website
Internet
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Ohio Dept of Education
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Other
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Reason for choosing ECOT:
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Safety Concerns
Religious Beliefs
Medical Issues
Mental Health Issues
Socialization Issues
Peer Pressure
Transportation Issues
Ability To Work At Own Pace
Work Schedule Related
Interest In Computers
Incompatible With Current Environment
Move From Home Schooling
For My Learning Style
Other
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Do you want to use your own PC instead of an ECOT PC?
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No
Undecided
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For which school year do you want to apply?
2012-2013
2013-2014
Have you (or your children) enrolled in ECOT before?
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Potential ECOT Students
Student #1
First Name
*
Last Name
*
Birth Date (MM/DD/YYYY):
*
Entering Grade
Select One
Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
*
Student #2
First Name
*
Last Name
*
Birth Date (MM/DD/YYYY):
*
Entering Grade
Select One
Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
*
Student #3
First Name
*
Last Name
*
Birth Date (MM/DD/YYYY):
*
Entering Grade
Select One
Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
*
Student #4
First Name
*
Last Name
*
Birth Date (MM/DD/YYYY):
*
Entering Grade
Select One
Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
*
