Part-Time Middle School Enrollment Application Jeffco's 21st Century Virtual Academy 2018/2019
Potential students and their parent/guardian must complete the required enrollment steps before finalizing their enrollment in Jeffco's Virtual Academy. (Please note enrollment into Jeffco's Virtual Academy is not automatic). Part-time students will be enrolled in classes based on space availability and will be notified if they have been enrolled after April 13.
I understand that filling out this survey is the first step of the application process. I understand my student's enrollment is dependent upon successful completion of the Introduction to Jeffco's Virtual Academy and that all required paperwork has been submitted and reviewed by the registrar. *
Required
I acknowledge that this application is for middle school courses only. I understand a response will not be generated if this application is for any other grade level other than middle school.
If you need high school or credit recovery courses, please return to our website for the appropriate application.
Student's Last Name *
Please provide student's legal last name
Your answer
What is your Jeffco Student ID Number? *
Your answer
Student First Name *
Please provide student's legal first name
Your answer
Student Middle Name *
Please provide student's full middle name
Your answer
Name of Current Middle School *
Your answer
Student Grade Level for the 2018/2019 School Year *
Your answer
Name of Current Counselor and email address *
Your answer
Student Birthdate *
Your answer
Student Email Address *
Your answer
Student Phone Number
Your answer
Parent/Guardian Name *
Please provide the name of student's parent/guardian
Your answer
Parent Phone Number *
Your answer
Parent Email Address *
Your answer
Please Enter Parent Email Address Again *
Your answer
Home Address *
Your answer
City/Town *
Your answer
State *
Your answer
Zip Code *
Your answer
Relationship to Student *
Your answer
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