EVSC Virtual Academy School@Home Application 2017-2018
Please complete all sections of this application and submit. Applicants and their parents will be contacted by email to attend an information/enrollment meeting at the Virtual Academy office.

We are current accepting applications for our second semester courses which will begin in January, 2018. Our enrollment meetings are scheduled to begin in mid October, 2017.

First Name *
Your answer
Section I - Student Information (all Information must be completed)
Last Name *
Your answer
Middle Initial *
Your answer
Student email address *
Must be the email address the student will regularly check - cannot be the same as the parent email address. Current EVSC students should list the EVSC Google email address.
Your answer
Date of Birth *
XX/XX/XXXX
Your answer
Gender *
Race *
Select from the list
Street Address *
Your answer
City *
Your answer
State *
Required
ZIp Code *
Your answer
Home Telephone Number *
Please include area code and phone number (XXX-XXX-XXXX)
Your answer
Cell Phone Number *
Please include area code and phone number (XXX-XXX-XXXX)
Your answer
Section II - Parent/Legal Guardian Information (all information must be completed)
Parent/Guardian Last Name *
Your answer
Parent/Guardian First Name *
Your answer
Parent/Guardian Email Address *
Must be a different email address than the student email address
Your answer
Parent/Guardian Street Address *
Your answer
City *
Your answer
State *
Required
Zip Code *
Your answer
Home Telephone Number *
Please include area code and phone number (XXX-XXX-XXXX)
Your answer
Cell Phone Number *
Please include area code and phone number (XXX-XXX-XXXX)
Your answer
Does the parent/guardian listed have legal custody of the student? *
Required
Section III - Current or Last School Attended Information (all information must be completed)
School address and School Phone Number is required for schools outside the Evansville Vanderburgh School Corporation
School Name (current school or last school attended) *
Your answer
School Street Address (if school is outside of the Evansville Vanderburgh School Corporation
Your answer
School City (if school is outside of the Evansville Vanderburgh School Corporation
Your answer
School State
School Zip Code (if outside of the Evansville Vanderburgh School Corporation
Your answer
Guidance Counselor Name *
Your answer
Guidance Counselor Email Address *
Your answer
Student's Current Grade in school *
What grade is the student currently enrolled or level of work at home
Required
Section IV - Support Services
Please answer the following questions regarding academic support
Does the student have an active Individual Education Plan (IEP) for which he/she receives accomodations? *
Required
Does the student have an active 504 Plan for which he/she receives accomodations? *
Required
Name of the Learning Coach who will mentor the student at home *
Your answer
Learning Coach Email Address *
Your answer
Application Submitted by *
Your answer
Email Address to Receive Verification of Application Submission *
Your answer
Submit
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