2018-19 TVLA Registration
Required for student to be enrolled. Email address below is from adult (principal, counselor, etc...) completing this form. Student login will be provided within 1-2 business day(s).
Email address *
Student FIRST Name *
Your answer
Student LAST Name *
Your answer
Student Middle Name *
Your answer
Student grade level *
Is this student 13 years of age or younger?
Student ID # (SSID) *
Your answer
IEP/504? *
Copy of IEP/504 must be scanned to william.young@trumbullesc.org
Reason for TVLA
Please include details (e.g., if a student was expelled for bringing a weapon to school).
Your answer
Probation officer?
Full-time Trumbull students only. If yes, please list name and contact information.
Your answer
Home Address
Full-time Trumbull students only.
Your answer
Home phone
Full-time Trumbull students only.
Your answer
Parents/Guardians Names
Your answer
Parent cell phone
Full-time Trumbull students only.
Your answer
Parent email address
Full-time Trumbull students only.
Your answer
School administrator/counselor approving VLA courses to be taken *
Your answer
School counselor/lab monitor assigned as student's mentor
Will have access to view student's progress and be able to assign parent/guardian access.
Your answer
Payment
Start date
Please note: A credit recovery semester course end date is 9-weeks from start date.
Your answer
School administrator/counselor phone number
Your answer
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