23-24 Change of Enrollment Request (v2)
Please fill out this form if you are planning on transferring your student out of Deeper Learning Virtual Academy.

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Email *
Student District ID Number: *
Student Last Name: *
Student First Name: *
Student Grade: *
Parent/Guardian Name (Last name, First name): *
Parent/Guardian Phone Number: *
An enrollment request MUST be confirmed verbally or via email by the adult legally entrusted to make education decisions.
Transfer or Withdrawal:
Clear selection
In-District School: if you are transferring back into an assigned WAWM school. *
To find your neighborhood school, please use the digital tools found in this web page: https://www.wawmsd.org/enroll/attendance-areas
What is the primary reason that you are transferring your student out of DLVA?
 *
Office Hours Return: *
Keeping school equipment past the effective withdrawal date constitutes theft of school property. Any school-issued equipment is due back within 10 days of the effective withdrawal date to the DLVA office in the Madison Elementary building located at 1117 S. 104th St. Our office hours are Wednesdays from 12pm to 3pm and Fridays from 8am to 12pm. Please indicate a time below that works best for your schedule. 
Date of Return: *
Please select the Wednesday or Friday that you will return all of your school-issued equipment.
MM
/
DD
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Equipment Inventory: *
Please check the box next to each item you have borrowed from DLVA. Consumable workbooks (with places for students to fill in with pen/pencil) should NOT be returned.
Required
DISCLAIMER: WI Stat § 943.70 (2017) states: "Whoever willfully, knowingly and without authorization does any of the following may be penalized as provided in par. (b): Destroys, uses, takes or damages a computer, computer system, computer network or equipment or supplies used or intended to be used in a computer, computer system or computer network."
 *
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