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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 *
If the student is not currently enrolled with WISD, please be prepared to provide most recent discipline, attendance records and latest report card within three days of this application submission.  *
If currently enrolled in WISD Schools, please supply student ID number
Student email *
Student phone *
Parent/Guardian First Name *
Parent/Guardian Last Name *
Parent/Guardian Relationship to student *
Parent email *
Parent phone *
Student Home Address *
If your student is currently enrolled with a program or district other than WISD, please be prepared to provide valid/certified documentation of your accredited program within three days of submitting this application. *
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? *
The student and parent both acknowledge that the current virtual instruction offerings of WHS do not include any recovery courses nor any advanced or dual credit courses. These virtual courses are designed to meet the needs of students seeking original, foundation plan  HS credit. *
Required
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. *
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