Learner Change Form
The requested changes will be made to all primary VCA accounts assigned to the learner, parent and PM (Moodle, Power School) Please note that changes may take time to be processed.
Email Address
* Required
Your answer
What Learner's Name is affiliated with the account that needs to be changed?
* Required
Your answer
Which VCA Campus is the learner currently assigned to?
* Required
Which learning path is the learner currently on?
* Required
What is the change you are requesting?
* Required
If Learner is changing HQC or Advisor, please list the current and new HQC (i.e. Marty Troutman; Judy Culp)
Your answer
If new mailing address, list here.
Include street or box, city, state and zipcode.
Your answer
If new email address, list here
Your answer
If phone number change, list OLD number which needs to be removed
Include area code with phone number (xxx) xxx-xxxx
Your answer
If phone number change, list NEW number which needs to be added.
Include area code with phone number (xxx) xxx-xxxx
Your answer
If request is to change learners assigned VCA campus, choose one of the following.
Changes have to be approved by the appropriate director. The director will verify there is space available at the requested campus prior to a switch being made.
If primary mentor has changed, please list new name, phone number, address, and whether or not the PM is the guardian of the learner.
Your answer
Additional information related to change request
Your answer
Name and relationship to learner of person submitting change form
* Required
Your answer
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