Green Valley "Success" Academy Application Submission 2018/2019 SY
Please complete this brief questionnaire and upload the application along with all supporting documents. If you have any questions please contact Terri McColl at 301-817-3100 ext 74745 or email me at The parent will be called for an interview once all documentation as been received. Instructions: Click to download the GVA application, complete the form below and upload the completed application and supporting documentation where indicated. Please submit applications by July 15th if you want the student to be considered for enrollment in the 1st semester.

Please keep in mind that we do not accept first time 9th graders unless the student is expelled or court ordered to attend Green Valley "Success" Academy.

Email address *
Did you download the hard copy of the 2 page application from *
Student's Name & Date of Birth *
School Name *
For which semester are you applying? (Parents will be contacted over the summer for orientations) *
Student Id # *
Professional School Counselor name, email address & phone number *
Parent Name and Contact information *
Student's Grade level *
Reason for Referral- Check all that apply *
Number of credits (if applicable)
Did you include the FBA? *
Upload FBA *
Did you include the current Behavior Intervention Plan? (Applications will not be processed without a current implemented plan) *
Upload Current BIP. BIP must have been implemented for at least 3-4 weeks prior to submitting application. *
Did you include SIT notes from this school year? (Applications will not be processed without SIT notes from the current school year.) *
Upload SIT notes
Does the student have an IEP? If so, the SPED chair must sign the application as well. *
Upload current IEP
Has the school begun the SPED screening process? (The screening process must be completed prior to submitting an application.) *
Does the student have a current Section 504 Plan? If so, the Plan must be up to date and uploaded as a PDF document. *
Upload current 504 Plan
Student Documentation Checklist (Put a check mark for all attached documents) *
Upload application along with all other supporting documents. *
A copy of your responses will be emailed to the address you provided.
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