2023-2024 Claiborne Virtual Learning Academy Student Application

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Claiborne Virtual Learning Academy Student Application

Student First, Middle, and Last Name *

Student Date of Birth (Month, Day, Year) *

Student Age in Years as of Today *

In What Grade Will Student Be as of August 2022? *

6th

7th

8th

9th

10th

11th

Legal Parent/Guardian(s) Name(s) *

Physical Address of Student (House Number, Street, City, State, and Zip Code) *

Mailing Address of Student if Different from Physical Address (PO Box, City, State, Zip Code) *

Parent/Guardian Phone Number(s) (Indicate landline or mobile number) *

Student Mobile Phone Number if Available *

Parent/Guardian Email Address *

Student Email Address *

1. Does this student currently receive special education services? Yes or No If ,"Yes," please describe services received. *

2. Does this student have a 504 plan? *

Yes

3. Do you have a reliable computer or laptop at home (this does not include tablet devices)? *

Yes

4. Do you have reliable Internet connectivity at home? *

Yes

5. Is this student currently enrolled in school? Yes or No If, "No," please explain here. *

6. Is this student currently attending school? *

Yes

7. If this student is currently attending school, where is he/she enrolled? *

8. Is this student currently in an alternative education program / school? If, "Yes," please explain here. *

9. Has this student ever been enrolled in an alternative education program/school? If, "Yes," please explain here. *

10. Please explain why you are interested in enrolling your student in Claiborne Virtual Learning Academy. *

11. Please explain any concerns or needs your student has of which Claiborne Virtual Learning Academy needs to be aware. *

12. Please allow the student to explain in his/her own words here why he/she wants to attend Claiborne Virtual Learning Academy. *

Assurances - Check All in Agreement. *

We understand that we are committed to following ALL the rules and guidelines as set forth in the Claiborne Virtual Learning Academy Handbook.

We understand that the student is committed to working a minimum of 30 hours per week.

We understand that the student is committed to attending a minimum of one class block per week in person at the CVLA center, attending any tutoring, mandated testing, and the parent/guardian attending teachers' meetings as scheduled. This includes the parent/guardian providing reliable and consistent transportation for the student.

We understand that the Claiborne Virtual Learning Academy is not an Alternative Education program or school. Students must be eligible to attend traditional school in order to apply to CVLA.

Required

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