Collinsville Virtual Academy (CVA) Student Application

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Thank you for completing the CVA Application. The CVA Instructor will make contact with the student in August. Students need to check their school email for updates from their counselor. High school counselors will email information regarding student schedules and appointments in August.

Email *

1. Student Name *

2. Student Collinsville Public School Email *

3. I am applying for: *

Blended Learning (Traditional Classes at School & Virtual Classes)

Full Time Virtual

Other/Administrative Placement

4. Grade Level for the 2020-21 School Year *

6th

7th

8th

9th

10th

11th

12th

5. Address (Student must reside in the Collinsville School Distrct or currently enrolled as a student in Collinsville Schools.) *

6. Parent/Guardian Name *

7. Parent/Guardian Contact Number & Email *

8. Other Contact Name & Number *

11. Mark any that might apply to you: *

Concurrent Enrollment (College Courses for Qualifying Juniors & Seniors)

Tulsa Tech

Athletics

IEP

504

Vocational Agriculture

Band

Vocal Music

None

Required

12. What aspect of the program specifically interest you? *

13. What are your educational goals? *

14. How do you feel this program would help you achieve your goals? *

15. What challenges do you see with your enrollment in the program? *

16. Please check the boxes to acknowledge your agreement with each of the following statements. I understand that: *

I will be expected to check in with the CVA instructor weekly, complete seat hours as directed if necessary, and comply with his/her directions.

I am required to attend class meetings, mentoring sessions, and meetings with counselors/administrators.

Enrollment in online courses must meet all state mandated compulsory attendance requirements, and I am not exempt from state truancy laws.

I must maintain satisfactory attendance by logging on and accessing courses on a regular basis. If a course is not accessed for 10 consecutive school calendar days or the student is behind more than 20 activities, the student is at risk of having the course disabled and/or being dismissed from the virtual program. A student violating the attendance requirement may face consequences. Consequences could include the following: 1) being returned to the traditional setting for disciplinary measures or 2) withdrawn from enrollment from Collinsville Public Schools and noted as a dropout.

I must maintain a minimum of 60% in coursework to advance through the program. In house seat hours may be reduced for students who are within 3% of target and maintain a 70% or better in the course.

I can be permanently dismissed from the Collinsville Virtual Academy for violation of plagiarism, cheating, or inappropriate communication found in violation of the Internet Acceptable Use Policy. This includes copying and pasting directly from internet sites.

I must complete the Student Internet Access Agreement for Collinsville Public Schools.

Each student is to use their assigned login/password and will not access other student work or folders.

Test and exams may be required to be proctored in the lab per the CVA instructor.

The content of the online courses is as rigorous as that found in the traditional school setting and an equal number of hours are expected from students to ensure course completion at the close of the academic semester.

All rules and policies of Collinsville Public Schools are applicable to me as a virtual student. The student handbook and district policy book are located on the school website.

Required

Student Signature & Date *

Parent/Guardian Signature & Date *

Counselor Signature & Date

CVA Instructor Signature & Date

A copy of your responses will be emailed to the address you provided.

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