Spring 2021 JVS Enrollment Form
Please complete all sections and call Mrs. Davis with any questions at 918-253-4466 ext. 3170
Email address *
Student Last Name *
Student First Name *
Grade *
Birthdate *
Email Address of Student *
Student's Cell Phone # *
Physical Address *
Are you 18 or over? *
Did you attend Jay Public Schools in the 2019-20 School Year? *
Parent/Guardian Names *
Parent/Guardian Phone Number *
Parent/Guardian Email Address *
Are you on an IEP? *
If yes, who is your teacher of record?
Are you on a 504? *
If yes, for what health condition?
Do you currently live within Jay School District Boundaries? *
Do you have access to a laptop or tablet for coursework? *
Do you have internet access at home? *
Are you behind in credits? *
Have you previously applied to Jay Virtual School? *
Are you wanting to complete all of your coursework online or only a portion? *
If only certain classes, please specify the courses you are wanting to take through JVS?
Why are you wanting to attend JVS? Be as specific as possible. *
Is there anything you feel the committee should know about you or your circumstances before you interview? *
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