Edgewood City Schools Virtual Academy Application

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Edgewood City School has made a commitment to offer a progressive competency based online approach to learning that will assist students in developing life skills, work independently, reach educational goals, and prepare for future opportunities.

Please fill out the application below application, and someone will contact you regarding your application. Any questions regarding the application please feel free to contact the students guidance counselor or the virtual academy coordinator John Cecere. john.cecere@edgewoodschools.net

Email *

Student First Name *

Student Middle Name *

Student Last Name *

Student Email *

Student Date of Birth *

YYYY

Parent/Legal Guardian Name *

Home Address *

Parent/Legal Guardian Phone Number *

Parent/Legal Guardian Email *

Secondary Contact Name/Relationship to Student *

Secondary Contact Phone Number *

Secondary Contact Email *

Student Current Grade *

Other:

What year did the student start 9th grade *

Current School/Other schools attended

Grade Entering Next School year *

Other:

Is student on IEP, 504, Or Behavior Plan *

Significant Medical Issues of the student *

Does the student have any significant behavior or academic issues? If yes explain *

Reasons for applying for the Virtual Academy *

Does the student have a probation officer or diversion officer. If yes please provide name and phone number *

Is the student employed? If yes name and number of employer *

Career Interest of the student *

Virtual Academy Placement *

Morning Session: 7:30am-10:00am Grades (11 & 12)

Afternoon Session: 12:00pm-2:30pm (Grades 9&10)

At Home Option: Must have medical documentation

By agreeing below, I acknowledge that I have read and understand all of the information contained in the Virtual Academy informational packet. I agree to abide and support the Edgewood City's Student Code of Conduct and all other board policies.

Although the Virtual Academy information reflects current program policies, I understand that it may be necessary to make changes to better serve the need of the program and its students.

I Agree

I disagree

Required

A copy of your responses will be emailed to the address you provided.

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