Request edit access
Virtual Instruction Program (VIP) Application Waxahachie ISD
This form serves as a students application for Waxahachie ISD Virtual Instruction Program grades 9-12.  District enrollment must be completed as well before acceptance into the program can be granted. 
Email *
Student Last Name *
Student First Name *
Grade level this fall *
Date of Birth *
MM
/
DD
/
YYYY
Current campus student is enrolled with *
Student email *
Student phone *
Parent/Guardian First Name *
Parent/Guardian Last Name *
Parent/Guardian Relationship to student *
Parent email *
Parent phone *
Student Home Address *
Reason for requesting Virtual Instruction Program Enrollment *
Has the student previously received or  is the student currently receiving, services in in any of the following areas? *
Student Self Assessment. Student , please answer the following honestly. *
Strongly Agree
Agree
Nuetrel
Disagree
Strongly Disagree
Time Management - I can manage my time effectively and meet deadlines without frequent reminders.
Independent Learning - I am comfortable learning independently and seeking help when needed.
Technology Skills - I am confortable using computers, email, online learning platforms, digital tools.
Communication - I regularly check email and can communicate with teachers when I need assistance.
Academic Commitment - I understand that virtual learning requires daily participation and consistent effort.
Student Reflection. What strengths will help you be successful in a virtual learning environment? *
Student Reflection. What challenges do you anticipate in virtual learning, and how will you address them? *
Parent/Guardian Commitment. Please indicate yes or no for each question. *
Yes
No
Maybe
I understand that virtual learning requires daily student participate and engagement.
I understand that students are expected to complete coursework according to established pacing requirements.
I agree to monitor my student's academic progress regularly.
I understand that students may be returned to a traditional campus placement if virtual learning is not meeting their academic needs as determined by WISD.
I understand that attendance requirements established by the Texas Education Agency and Waxahachie ISD still apply in a virtual setting.
I agree to maintain communication with school staff regarding my student's progress and success.
Technology Access *
Yes
No
Not sure
Does the student have reliable internet access at home?
Does the student have a dedicated space for learning?
WIll the student have access to reliable technology device like a laptop or desktop computer for learning?
Student Agreement *
Yes
No
Not sure
I understand that enrollment in Waxahachie Virtual Instruction Programs require me to participate daily, complete assignments on time, communicate with my teachers, and uphold Waxahachie ISD expectations.
Student Agreement - By typing your first and last name in the space provided, you are electronically acknowledging your agreement with the previous question. *
Parent/Guardian Agreement - I certify that the information provided is accurate and understand that acceptance into the Virtual Instruction Program is based upon review of academic, attendance, behavioral and program suitability factors. *
Required
Parent/Guardian Agreement - By typing your first and last name in the space provided, you are electronically acknowledging your agreement with the previous question. *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Waxahachie ISD.

Does this form look suspicious? Report

Google Forms