Levy Virtual School
Application for Enrollment
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Email *
Student Name *
Student Date of Birth *
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/
DD
/
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Student Gender *
Grade level of student during last school term attended *
Parent/Guardian Phone # *
Parent/Guardian Email Address *
Physical Address *
School student attended during last school term *
Why are you interested in enrolling in full-time virtual education and, if accepted, how long do you plan to remain in full-time virtual education. 
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