24-25 School Year Eligibility Form

If you are interested in Hernando eSchool please fill out this form. This is NOT your registration, you will be notified by email if you meet our eligibility qualifications for our Full-Time Program.

Today's Date Today's Date / MM / DD YYYY
Student Name Student Name First Middle Last
No Nick Names Please
Student ID

If you are new to the district and do not have a student ID number, please use 0 (zero) as the student ID.
Student email address
(You will be notified about registration and receive your class schedule through this email)
What is the current school that you are attending?
Grade level your child is in this school year.
Grade level your child will be in for the next school year.
Gender
Date of Birth Date of Birth / MM / DD YYYY
Parent/Guardian Name Parent/Guardian Name First Last
Parent email address
(You will be notified about registration and receive your class schedule through this email)
Do they have a current IEP?

Do they have a current IEP? Yes No
Do they have a current 504?

Do they have a current 504? Yes No
Phone Phone - ### - ### ####