Everett Cyber Academy: Application
To request enrollment in the Everett Cyber Academy, please complete the form below. Once your form is submitted, it will be reviewed by a staff member and you will be contacted.
Email address
Student Information
First Name:
Your answer
Last Name:
Your answer
Gender:
Birthdate:
MM
/
DD
/
YYYY
Current Grade (if completing during summer months, enter grade for upcoming school year):
Is the student currently enrolled at Everett Area School District?
If you answered "No" to the previous question, what school was the student most recently enrolled?
Your answer
Phone Number:
Your answer
Address:
Your answer
Email Address:
Your answer
General Information
Which type of cyber enrollment are you requesting?
Please describe your reason for requesting cyber. Please provide as much detail as possible.
Your answer
Information of Individual Making Request
First Name:
Your answer
Last Name:
Your answer
Home (or Primary) Phone Number:
Your answer
Cell Phone Number:
Your answer
Work Phone:
Your answer
Address:
Your answer
Email Address:
Your answer
Relationship to Student:
A copy of your responses will be emailed to the address you provided.
Please complete the captcha before submitting the form.
Submit
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