Application for Membership Farmville Area Christian Homeschool Co-op Are you a current co-op member? Yes No *Contact Info* Father's First Name: Father's Last Name: Mother's First Name: Mother's Last Name: Home Address: City: State: Zipcode: Home Phone: Mom's Cell Phone: Dad's Cell Phone: Other Phone: E-mail Address: *Children* Please include all children who will be participating in co-op classes and any younger siblings who will be in the nursery. Add Child Background How long have you been homeschooling? Have you ever been a member of this co-op in the past? No Yes If yes, what years? The following four questions help us screen applicants to ensure the safety of our families. A yes answer does not automatically disqualify you as a member of the co-op, but may require further investigation and discussion: Have you ever been convicted of a felony? No Yes If yes, please explain: Does social services have a case open against your family? No Yes If yes, please explain: Has your child been expelled or suspended from school? No Yes If yes, please explain: Does your child have any special needs we should be aware of? No Yes If yes, please explain: In addition to this application form, the teaching parent(s) is required to submit information and approval for a background check. Download those forms here: Applicant Data Collection Form Background Investigation Notice References Who referred you to the co-op? First Reference Name: Relationship to you: Phone: E-mail: Second Reference Name: Relationship to you: Phone: E-mail: Church & Faith Church you regularly attend: Church location: Pastor's Name (if your church doesn't have one, put "none"): Pastor's Phone Number: Do we have your permission to call your pastor as a reference? Yes No What current activities help your family to grow in your relationship with the Lord? Is there anything else you would like us to know about your or your family's faith? Teaching Background Mother's educational and career background: Father's educational and career background: Parents' Hobbies, Gifts, Talents, and Abilities: What are you particularly passionate about or good at? *Teaching Preferences* What subject(s) would you most like to teach? What age(s) would you prefer to teach (groupings are subject to change based on actual membership): 3-4yo 5-6yo 7-9yo 10-12yo 13yo+ Any age is fine. *Commitment* Is there any reason you foresee which might make it necessary for you to forgo your teaching commitments during the next school year? No Yes If yes, please explain: We share teaching commitments, and it is very important to the rest of the group that you keep your commitment to teach. Do you hereby commit to teaching during your scheduled time slots? Yes No We can sometimes make accommodations/adjustments in our requirements for families in unusual situations. For example, we will assign teaching duties either well before or well after a pregnant mother's due date. Such accommodations must be discussed and approved by the whole group in advance. If you would like to be a part of co-op, but have special circumstances that make it difficult for you to meet all our usual requirements, please contact our coordinator to discuss these options. Vow of Commitment Please check each statement that is true for you. I have read the Statement of Faith and our family shares these beliefs. I have read the rules and expectations and agree to abide by the rules and regulations of Farmville Area Christian Homeschool Co-op. We will respect others and conduct ourselves in a way that pleases our Lord Jesus Christ. I will respect and care for the building and I will carefully see that the students in my care do the same. I release the Farmville Christian Homeschool Co-op and St. John’s Lutheran Church from all liability of accidental injury occurring during co-op activities. I commit to fulfilling the shared obligation of teaching the students of the co-op, and I will pursue excellence in teaching. I will encourage my children to do their best in their classes and will make sure they complete their homework assignments. If I fail to meet these expectations, I understand that another member of the co-op will privately and lovingly make me aware of it. If it continues to happen, I may be asked to leave the co-op. I have read Matthew 18:15-17. I welcome others to privately and lovingly tell me if there are any issues of concern. If I am concerned about the behavior of another member of the co-op or the behavior of their children, I will talk privately with them and resolve it lovingly and peacefully. If the behavior continues, I will bring it to the attention of the co-op leader and we will meet with that person to resolve the issue. I will not tear down the reputation of other members of the co-op by gossiping, but I will protect the unity of the group and will resolve conflict in a Biblical manner. *Other* Is there anything else you would like us to know about you or your family as we are considering your application? Is there anything you would like to see us do differently from last year? *Submit* By submitting this form, you indicate that you have read and understand our policies, agree with our Statement of Faith, and commit to fulfill your teaching responsibilities if accepted.