Worksheet

Wholehearted Leaders Alternative Education Program Application Form - 2022/2023


Please fill out this application form for EACH child you are registering.

Completed applications will be reviewed, and our team will be in touch to set up an interview or confirm your acceptance into the program.

 

Wholehearted Leaders is not an independent school.

The Emotional Literacy Movement (ELM) is offering alternative educational programming to parents and families as an addition to the family's home education initiatives.

ELM is not responsible for meeting Manitoba curriculum outcomes for your child's grade level, however, our educators are skilled at meeting many of these outcomes through the Wholehearted Leaders Program.

At the end of each block we will provide you with a summary of the outcomes covered so you may add it to your child's portfolio.

If you are pulling your child from a public or private school setting, you must submit your intent to homeschool to Manitoba Education.

In order for us to process and accept your child into the program it is essential you clearly communicate your commitment to our program throughout the 2022/2023 school year. Our program is a grassroots movement, currently funded entirely by our families. We love and value our educators and want them to feel assured they will have committed families throughout the year. 




1.

Family Information

2.

Are you homeschooling for the 2022/2023 school year?

In order for us to process and accept your application we need to know you will be homeschooling for the 2022/2023, and committed to the programming.

3.

Full name of child

Also, please let us know if they prefer to be referred to by a specific name, or shortened version of their name

4.

Gender of child

Gender and pronouns please.

5.

Date of birth

6.

Parent/Guardian #1 Information

Please provide name, and phone number of the parent/guardian.

7.

Parent/Guardian #2 Information

Please provide name, and phone number of the parent/guardian.

8.

Emergency Contact Information

Please provide name,  phone number, and relationship to the learner(s) of 1 or more emergency contacts.

9.

Has your child had experience in a public school or another educational setting?

Please describe the positives and negatives of that experience, and why you've decided to seek alternative education. 

10.

What are some of your child's interests? *

Think beyond the extra-curricular activities they might be involved in.

What inspires them?

What are they naturally drawn to?  

What topics do they enjoy talking about? 

11.

What are your child’s strengths?

Physical, social, emotional, cognitive.

The more info the better!

12.

What are your child's challenges?

Physical, social, emotional, cognitive. 

The more info the better.

13.

Does your child have any special needs or disabilities? If so, please explain.

Currently, our program does not have extra supports or funding, should a child require a 1-to-1 support educator. 

14.

Does your child have any medical conditions? If yes, please describe.

15.

Does your child have any allergies or sensitivities? If yes, please explain.

16.

What interests you about The Wholehearted Leaders Alternative Education Program?

17.

What does community mean to you?

18.

What are your 5 core values?

19.

Based on the programming blocks listed, which blocks is your family registering for?

Autumn Block 1: September 13th - October 20th (6 Weeks)

Autumn Block 2: November 1st - December 15th (7 weeks)

Winter Block 1: January 10th - February 23rd (7 weeks)

Winter Block 2: Intended for mostly indoor specialty camps, game clubs.. Dates to be decided. If the weather is mild, we will endeavour to continue programming at Hawthorne Valley Farm when it makes sense to do so. Community will be part of the process as we get closer to the block

Spring Block 1: April 4th - May 11th (6 weeks)

Spring Block 2: May 23rd - June 29th (6 weeks)

Summer Blocks: Will be offered at some capacity, as it is essential to continue to build on work done on the land through the summer months. Dates to be announced. 

20.

How many days per week are you committed to?

21.

How do you feel about your child(ren) engaging in risky play?

22.

ELM will be reviewing applications, and setting up dates for in-person interviews at Hawthorne Valley Farm. Please choose from the dates provided, which dates would work for your family to attend

These interviews are casual, and will give your family the opportunity to tour the land, meet the educators, and ask any questions you have.

Note: If your family has been part of the Wholehearted Leaders pilot program with BCA for 2021/2022,  you will not need an in-person interview prior to acceptance into the program.

23.

Payment Information

Upon acceptance into the program, a $300 deposit is required to hold your space. The $300 will be applied to your program tuition total.

You will have the option to pay in full for the 2022/2023 year, or in 10 equal increments ( +3% transaction processing fee) beginning September 6th, 2022 

Tuition rates: $150/per week +GST (All 3 days), $120/per week + GST (2 days per week), or $70/per week + GST  (1 day per week)

 



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