Archdiocese of Miami Virtual Catholic School (ADOM-VCS)
Email any questions or concerns to Ms. Rebeca Bautista, principal, at principal@adomvirtual.com.

Thank you for your ongoing support of Catholic education.

Email address *
Enrollment Form: Fall 2017
Is this your first time taking a course with ADOM-VCS? *
STUDENT Last Name *
Last Name will be used to create student account; username will be created, based on information included here.
Your answer
STUDENT First Name *
First Name will be used to create student account; username will be created, based on information included here.
Your answer
Current Grade *
Requested Start Date *
MM
/
DD
/
YYYY
Requested End Date (latest date is 12/22/2017) *
MM
/
DD
/
YYYY
Student Type: *
Name of current school: *
If Home School, enter the name of the curriculum provider/group or district.
Your answer
E-mail Address - Student *
Your answer
Date of Birth - Student *
MM
/
DD
/
YYYY
Gender - Student *
Birth Country - Student *
Your answer
Primary Language - Student *
Your answer
Social Security Number - Student *
SSN is used for identification purposes only - if you do not wish to share SSN, the student's date of birth will be used in a situation where a unique student identifier is requested. Enter either SSN or N/A.
Your answer
Mailing Address - Student *
Only street address - city, state, zip code are separate entries.
Your answer
Mailing Address - Student *
City
Your answer
Mailing Address - Student *
State - two letter abbreviation
Your answer
Mailing Address - Student *
Zip Code
Your answer
Race - Student *
Mark all that apply - at least one is required.
Required
Are you, the student, a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish Culture or origin, regardless of Race? *
Required by Florida Department of Education and Archdiocese of Miami
Religion - Student *
Parent/Guardian Information
Enter "NA" if no information is available.
Parent/Guardian 1: *
PARENT/GUARDIAN 1 Last Name *
Last Name will be used to create student account; username will be created, based on information included here.
Your answer
PARENT/GUARDIAN 1 First Name *
First Name will be used to create student account; username will be created, based on information included here.
Your answer
Parent /Guardian 1 Email *
Your answer
Parent/Guardian 1 Primary Contact Number *
Your answer
Parent/Guardian 2: *
PARENT/GUARDIAN 2 Last Name *
Last Name will be used to create student account; username will be created, based on information included here.
Your answer
PARENT/GUARDIAN 2 First Name *
First Name will be used to create student account; username will be created, based on information included here.
Your answer
Parent /Guardian 2 Email *
Enter 'N/A' if student only has one primary parent/guardian.
Your answer
Parent/Guardian 2 Primary Contact Number *
Enter 'N/A' if student only has one primary parent/guardian.
Your answer
Course Request
Courses - Use 'ENTER' after each course name) *
Example: Algebra I/Semester 1, English III/Semester 2, Economics, World History/Full Credit
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Archdiocese of Miami Virtual Catholic School. Report Abuse - Terms of Service - Additional Terms