The version of the browser you are using is no longer supported. Please upgrade to a supported browser.Dismiss

Request edit access
Student Information
Complete the following information.
Email address
Last Name, First Name, Middle Initial
Your answer
Student ID Number
This is the 11-digit identification number that is found on your report card.
Your answer
Email Address
List an email that is checked daily as it will be used for communication regarding application status.
Your answer
Street Address
Your answer
City, State, Zip Code
Your answer
Parent/Guardian Name
Your answer
Relationship to Student
Required
Contact Number
Example: (000)111-2222
Your answer
Parent/Guardian Name
Your answer
Relationship to Student
Required
Contact Number
Example: (000)111-2222
Your answer
Next
Never submit passwords through Google Forms.
This form was created inside of Henrico County Public Schools. Report Abuse - Terms of Service - Additional Terms