E-Learning Contract & Course Request Form
Carefully read, review, and complete the following enrollment form. BEFORE you click the "Send Form" button (at the very end of this form), you and your parent/guardian MUST read all Contract terms and the Student Code of Conduct found at bit.ly/crsd-elrn-conduct.
Prior to completing the online portion of the Virtual Academy enrollment process, I verify that my parents and I have reviewed ALL portions and pages of the Virtual Academy Contract and Student Code of Conduct document. *
To access this document, go to bit.ly/crsd-elrn-conduct
Student LAST Name *
Your answer
Student FIRST Name *
Your answer
Student Birthdate *
Use the following format: Month/Date/Year (MM/DD/YYYY)
Your answer
Mailing Address *
Include box number and/or street address, city, state, and ZIP
Your answer
Student Email *
CRSD students: Please list your @crsd.us email address. If you aren't sure what it is, check with your e-learning lab mentor. Remember that email through Hotmail, Yahoo, Gmail, etc., may not be accessed at school.
Your answer
Student Phone Number *
Mobile phone and/or home phone where you can be reached when you are not at school.
Your answer
Current Grade Level: *
School *
Parent/Guardian Name *
Name of the parent/guardian who reviewed the Virtual Academy Contract & Online Enrollment documentation.
Your answer
Parent/Guardian DAYTIME Phone Number *
Mobile phone and/or other daytime phone number where parent/guardian can be reached
Your answer
Parent/Guardian Email Address *
Include the email address where e-learning grade reports and parent updates should be sent.
Your answer
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