Online Chaparral Virtual Program Enrollment and Transcript Request Form
Please complete this form if you are interested in enrolling in the Chaparral Virtual Program located at Chaparral Jr/Sr High School, 467 N KS-2, Anthony, KS. If you have questions, then you may call 620-842-5155 ext: 4303. The information you provide on this form when you click submit will be used to obtain educational transcripts to determine course placement and graduation requirements. You will be asked to sign this form with your electronic signature that grants permission for us to use your data for educational purposes. Also, when appropriate, your electronic signature grants permission for us to share your educational progress or current standing with legal entities and law enforcement agencies.
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Full Name? *
Maiden Name?
Street Address. No PO Boxes allowed. *
City *
State *
Zip Code *
Date of Birth *
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DD
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Age *
Social Security Number *
Phone Number *
eMail Address *
Gender *
Last Year You Attended School *
Do You Have a High School Diploma? *
Have you ever received special education services *
Do you have a computer? (computer access is required) *
Do you have Internet access? (internet access is required) *
What is your ethnicity? *
Are you employed *
Where are you currently working? *
How many hours per week do you work? *
Chaparral Jr/Sr High School has permission to release information pertinent to my education progress to the following:
If applicable, what is the name and phone number of the contact person in the previous question?
How did you hear about Chaparral Virtual School? *
Required
Transcript Request - Name of Last School Attended *
City and State of Last School Attended *
What year should you have graduated? *
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