Kelso Virtual Academy Parental Inquiry Form
The purpose of this form is to gather baseline information about your student potentially enrolling with the Kelso Virtual Academy (KVA).  This inquiry does not grant immediate acceptance into KVA.  A representative from the school will be following up with you to continue the enrollment discussion.

Process for applying to KVA
1)  Review our website for information about alternative learning options within the Kelso School District.
2)  Print this form and mail it to:  KVA,  2001 Allen St. Kelso, WA 98626, or, complete the form online in this link.
3)  After the staff review your application, we will inform you of the enrollment decision and if approved, set up a time to meet. COVID-19 guidelines may alter the location or arrangement of this meeting. At the conclusion of the meeting the applicant will be provided the required state, district, and program paperwork to be completed and submitted.
4)  You will receive an email or phone call letting you know the status of your student's application for enrollment once all required documentation and forms have been reviewed.

Please direct all questions to kva@kelsosd.org 
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Email *
Name of parent/caretaker who is completing this form: *
Best phone number to contact parent/caretaker *
Student Name (first and last): *
Student Date of Birth: *
Address Where Student Resides: *
Student Grade Level and Current KSD School , as of Fall of 2020 *
Has your student ever qualified for Special Education Services? If so, in what qualifying areas? *
Has your student ever participated in the following programs? Check all that apply *
Required
If you marked YES to any part of the previous question, please give the date range your student participated in those programs and any additional information you feel may be important for KVA staff to know.
Has your child ever been suspended from school or had discipline issues?  Please provide details if the answer is YES. *
Are there any medical or health concerns that the staff should be aware of?  Please provide brief details if the answer is YES. *
What school does the student currently attend? *
For the following questions, choose the best descriptor of your student:
Is punctual to activities and events *
Completes school work on time *
Uses time wisely *
Is a self starter *
Comes to school prepared *
Seeks academic help when needed
Gets along well with other students *
Gets along well with staff *
Shows respect for others and their belongings *
Any additional information or comments that you would like to add in regards to the academic and social habits of your child:
For this question, the student needs to answer in his or her own words.  Why are you considering alternative education? Discuss at least three reasons why alternative education and online learning would suit your needs and support your future goals. *
Upon submission of this inquiry the Alternative Education Registrar will contact you within the next three business days. Email kva@kelsosd.org for additional information.
NON-DISCRIMINATION STATEMENT
Kelso School District #458 complies with all federal rules and regulations and does not discriminate in any programs or activities on the basis of sex, race, creed, religion, color, national origin, age, veteran or military status, sexual orientation, gender expression or identity, disability, or the use of a trained dog guide or service animal and provides equal access to the Boy Scouts and other designated youth groups listed in Title 36 of the United States Code. The following employee(s) has been designated to handle questions and complaints of alleged discrimination: Holly Budge, Director of Human Resources, the school district's Title VII Officer and ADA Coordinator. People of disability may request reasonable accommodation in the hiring process by contacting, Holly Budge, Director of Human Resources, 601 Crawford Street, Kelso, WA 98626 or (360) 501-1924.

Inquiries regarding compliance procedures regarding students may be directed to Don Iverson, Director of Student Services, the school district’s Title IX Coordinator or Heather Ogden, Director of Special Programs, the school district’s Section 504 Coordinator, 601 Crawford Street, Kelso, WA 98626 (360) 501-1900.
A copy of your responses will be emailed to the address you provided.
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