Jeffco Virtual Academy Waitlist 2018/2019
Potential students and their parent(s)/guardian will be contacted by a Jeffco Administrator if space becomes available.

DO NOT USE THIS FORM FOR CREDIT RECOVERY

I understand that filling out this application is for the waitlist only and does not constitute automatic enrollment. I understand if accepted my student's enrollment is dependent upon successful completion of the REQUIRED enrollment steps. *
Required
I acknowledge that this waitlist application is for regular courses. I understand a response will not be received if this application is for any course/grade level other than what is stated in the application title. *
If you need credit recovery courses, please return to our website for the appropriate application.
Required
What is your Jeffco Student ID Number *
Your answer
Student Last Name *
Please provide student's legal last name
Your answer
Student First Name *
Please provide legal first name
Your answer
Student Middle Name *
Please provide full middle name
Your answer
Name of Current School *
Your answer
Student Grade Level for the 2018/2019 School Year *
Required
Comment (If you Selected Other please tell us why)
Your answer
Student Date of Birth *
Day, Month and Year (xx-xx-xxxx)
Your answer
Name and email address for Student's Current Counselor *
Your answer
Student Email Address *
Your answer
Student Phone Number
Your answer
Parent/Guardian Name *
Please provide the following information for student's parent/guardian
Your answer
Parent Phone Number *
Your answer
Parent Email Address *
Your answer
Please Enter Parent Email Address Again *
Your answer
Home Address *
Your answer
City/Town *
Your answer
State *
Your answer
Zip Code *
Your answer
Relationship to Student *
Your answer
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