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Floyd County Virtual Learning Program Application
This is an application for enrollment. Please note the following:
1. Individual Applications MUST be completed for households with multiple children.
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* Indicates required question
Sudent Name:
*
Your answer
Student Email Address:
*
Your answer
Parent/Guardian Name(s):
*
Your answer
Parent/Guardian Email:
*
Your answer
Address:
*
Your answer
Phone Number #1:
*
Your answer
Phone Number #2:
*
Your answer
Student's Date of Birth (mm/dd/yyyy):
*
Your answer
Current School:
*
Your answer
Grade for 26-27 School Year:
*
Your answer
Does the student have an IEP?
*
Yes
No
Does the student have a 504 Plan?
*
Yes
No
Why are you interested in being a part of the Floyd County Virtual Program?
*
Your answer
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