PVCA 2021-2022 Paperwork

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Please complete all required fields in order to prepare to pick up Pleasant Valley Cyber Academy materials for the 2021-2022 school year.

Today's Date: *

YYYY

Student's First Name: *

Student's Last Name: *

Student Home Address (Street Address): *

Student Home Address (City): *

Student Home Address (ZIP Code): *

Student Home Phone Number: *

Student Grade Level *

Does your child have any of the following?

IEP

GIEP

504

Not applicable

Parent/Guardian(1) First Name: *

Parent/Guardian(1) Last Name: *

Parent/Guardian(1) Address (if different from student):

Parent/Guardian(1) Phone Number: *

Parent/Guardian(1) Email Address: *

The main form of communication from PVCA is Email or Phone. Please make sure you have a correct email address and phone number with Voicemail that is set up. This will include weekly ILP reports.

Parent/Guardian(2) First Name:

Parent/Guardian(2) Last Name:

Parent/Guardian(2) Address (if different from student):

Parent/Guardian(2) Phone Number:

Parent/Guardian(2) Email Address:

This is the secondary email address to which we'll send weekly reports regarding student progress. Please type carefully.

Please specify your family's technology: *

We have a computer/device at home that can be utilized for PVCA.

We will need technology to be supplied by PVCA.

Contracts and Expectations Acknowledgement

By submitting this form, you agree that you have read and accepted the Contracts and Expectations that were attached to the informational email that you received.

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