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Request Information
1.
What county are you in?
Brevard
Flagler
Marion
Orange
Osceola
Volusia
2.
How many school age children do you have in the home that attend:
Pre-School
Elementary
Middle
High
Public
0
1
2
3
4+
0
1
2
3
4+
0
1
2
3
4+
0
1
2
3
4+
Private
0
1
2
3
4+
0
1
2
3
4+
0
1
2
3
4+
0
1
2
3
4+
Home
0
1
2
3
4+
0
1
2
3
4+
0
1
2
3
4+
0
1
2
3
4+
3.
How satisfied are you with the current education that your child receives?
Very satisfied
Satisfied
Not satisfied
4.
Might you be interested in sending your child to a Charter School in your area?
Yes
Possibly; tell me more
No
5.
Would you be interested in serving on the advisory board for the elementary school?
Yes
Possibly
No
6.
Would you be interested in serving on the advisory board for the middle school?
Yes
Possibly
No
7.
Would you like information mailed to you?
yes
no
8.
Please provide us with some information about you. (required fields are in
red
)
First Name
Last Name
M.I.
Street Address 1
Street Address 2
City
State
AA
AK
AL
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NA
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zipcode
Phone
Email
Comments/Questions
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