2021-22 Hempfield Virtual Academy: Grade K-6 Online Learning Enrollment Form

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

Thank you for your interest in enrolling a resident student in Hempfield School District’s K-6 full-time, online learning program. Upon verification and approval of eligibility, you will be contacted by the HVA coordinator, via the email provided below, with orientation details. Orientation will occur in August prior to the start of the school year. We look forward to working together to achieve Hempfield's vision of personal growth, achievement, and success for everyone!

Email *

Student First Name *

Student Last Name *

Date of Birth *

YYYY

Incoming Grade Level for 2021-22 School Year *

Current School Assignment *

Centerville Elementary School

East Petersburg Elementary School

Farmdale Elementary School

Landisville Intermediate Center

Landisville Primary Center

Mountville Elementary School

Rohrerstown Elementary School

Landisville Education Center

Student ID Number (Optional)

Parent /Guardian Name *

Street Address *

City *

Zip Code *

Preferred Phone Number *

Alternate Phone Number *

Does your student require special education services? *

Yes

Name of Special Education Case Manager (if yes selected above)

Level of Technology Skills *

Beginner

Intermediate

Advanced

Do you have access to Internet at your home? *

Yes

What type of connection do you have? *

Cable

DSL

Cellular

Other

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Hempfield School District. Report Abuse

Forms