Kelloggsville Virtual School--Secondary Application
Please complete this KVS Interest Form to show your intention of enrolling your student in the program, if accepted, for the 2021-2022 school year.  Once this form as well as the screener have been completed, KVS will reach out to you regarding your child's status. Thank you for your interest in Kelloggsville Virtual School!
Sign in to Google to save your progress. Learn more
Email *
Student's Last Name *
Student's First Name *
Name of parent/guardian enrolling student *
Phone Number *
Mailing Address *
Email Address *
Student's Date of Birth (mm/dd/yyyy) *
Are you a current resident of Kelloggsville Public Schools? *
If no, please share your resident district.
Did your child attend Kelloggsville Public Schools previously? *
If Yes, what was the last grade completed? What building did your student attend?
If No, give the last grade completed and list the previous school.
Does your child receive special services? *
Please list any services that your student has received.
Does your student have an IEP? *
Does your student have a 504? *
Was your student a virtual student during the 2020-2021 school year? *
If yes, what school did they attend?
Do you have internet access at home? *
If No, explain your plan for your child to complete an online education.
What made you choose to apply to Kelloggsville Virtual School? *
How did you hear about our program? *
What other schools are you considering? *
What are your plans for the remainder of your child’s K-12 education? *
I understand this is a stand alone school and acceptance to this program does not lend access to switching between other buildings within Kelloggsville Public Schools. *
I understand admittance to KVS does not guarantee admittance to any other school within Kelloggsville Public Schools. *
I understand that by enrolling in this program it is the expectation that my student remain enrolled for the entire school year. *
I understand that the virtual school may hold virtual sessions and will host academic drop in sessions that my child may attend to achieve the best success in this program. *
I understand that my child will be expected to come into a drop in session to take tests and get help when needed. *
I understand that virtual school provides flexibility but that my child will be mandated to attend in person for all state and district testing. *
I understand that my child may be asked to attend in person sessions or a virtual session on statewide count days (October and February of each year) and I will comply with the request. *
I understand that Kelloggsville may provide bussing for the academic drop in sessions to my child if they qualify. *
I understand that Kelloggsville Public Schools will provide an electronic learning device to my student to use and I am responsible for completing the technology agreement form and returning the device at the end of the school year or at the time of withdrawal from the program. *
I understand that virtual school is a commitment and that Kelloggsville Virtual School will provide quality learning experiences. It is my responsibility to engage my child in those activities and communicate with my child's teacher on a regular basis. *
I understand that KVS does not offer extra curricular activities or athletics at this time but that it may change in the future. *
For High School Students only: My student is currently on track to graduate and I will provide a copy of their transcripts ( if not previously at Kelloggsville) electronically to btravis@kvilleps.org or when I return this form in person.
Clear selection
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of Kelloggsville Public school . Report Abuse
Google Forms