Clinton Connect Application
School year applying for: 2019-2020
Email address *
Student Information
Last Name: *
Your answer
First Name: *
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Middle Initial:
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Date of Birth: *
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Student email: *
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Current Enrollment Information
Current Grade Level: *
Check All That Apply: *
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Virtual Enrollment
Select Your Virtual Enrollment Preference: *
Select your reason(s) for wanting to enroll in virtual course(s). *
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Select Your Course(s):
Select all courses interested in enrolling.
High School - Elective
High School - Advanced Placement
High School - Honors
High School - Comprehensive
High School - Core and Remedial Foundations
Credit Recovery
Middle School
Parent/Guardian Contact Information
Parent/Guardian #1
First Name: *
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Last Name: *
Your answer
Relationship to Student: *
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Address: *
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Phone Number: *
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Email: *
Your answer
Parent/Guardian #2
First Name:
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Last Name:
Your answer
Relationship to Student:
Your answer
Address:
Your answer
Phone Number:
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Email Address:
Your answer
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