Virtual Education Request Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please complete this form to submit a request for consideration for virtual coursework as part of MOCAP (Missouri Course Access and Virtual School Program). This coursework is usually provided by Launch, a virtual coursework provider directed by Springfield (MO) Public Schools. This request does not guarantee placement in virtual coursework. A separate form will need to be submitted for each student in a household requesting this coursework.

All students must obtain district approval prior to enrolling in a virtual course provided or paid for by the district. The deadline for requesting to enroll in virtual coursework is August 20, 2021. Approved placement will be contingent on the availability of enrollments in MOCAP course providers. If a student is approved to take a virtual course and does not actively participate in a course or is not progressing in the course, the district may remove the student from the virtual course and refuse to enroll the student in virtual courses in the future.

Student Name *

Student's Grade in 21-22 school year *

Name, e-mail, and phone number of parent/guardian: *

Does this student have a device available on which to complete virtual coursework - laptop, desktop, Chromebook, some tablets? This does NOT include district-owned devices. *

Yes, a device is available.

No, other than the school-issued Chromebook or tablet, no device is available.

Does the student have daily access to reliable internet services? *

Yes, there is internet access in the home.

No, there is no internet in the home.

Does this student have a health concern that prevents them from attending school on-site?

Yes, such a health concern exists.

No, there is no health condition.

Clear selection

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Iberia R-V. Report Abuse

Forms