Home School Support Program

Child's Name*

Last Name, First Name

SWTC Employee's Name*

Last Name, First Name

Date*

Child's Grade Level*

Access to Electronic Device*

Do they have access to their own device?

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Electronic Device Type*

Chrome Book, Desktop Computer, Laptop, Ipad, Cell Phone, etc..

Subject Assistance*

Please check all that apply

Select or enter value

Best Time*

Please check all that apply *Rank your top 3 if you have more than 1 timeframe that works in the Comments section.

Select or enter value

Special Interests

Music, Art, Sports, etc.

Comments

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