Cullman Innovation Academy Virtual School Registration for Fall 2021
This form is to be completed by prospective students and their parent/guardian. We will be in contact soon to discuss available courses for your child(ren) based on grade level and availability. Courses will be ONLINE with support from a Cullman City School certified educator. At this time, registration is ONLY OPEN to incoming 9th-12th grade students. Registration for CURRENT CCS students ends March 5, 2021.
Student Information
Student Name
Your answer
Street Address
Your answer
City, State, Zip
Your answer
Student telephone number
Your answer
Student email address
Your answer
Student Primary Language
Your answer
Do you have reliable access to a computer with internet access?
Yes
No
Other:
Clear selection
Are you willing to dedicate 30+ hours of active engagement to complete your learning activities and assignments each week? (Elementary average is 15 hours)
Yes
No
Other:
Clear selection
Are there elective or extra-curricular classes in which you prefer to participate?
Your answer
Will your coursework need to meet NCAA eligibility requirements? (high school students only)
Yes
No
N/A
Clear selection
Are you prepared to submit all coursework and assignments as original work completed by you? This means that all work will be completed by you, the student; collaboration will be approved by your instructor; you will not practice plagiarism; you will not allow others to copy your work; and you will not misuse content from the internet.
Yes
No
Other:
Clear selection
Do you understand that you will be required to attend on your school's campus any testing required by the Alabama State Department of Education?
Yes
No
Clear selection
2020-2021 School Name
Choose
Cullman City Primary School
East Elementary School
West Elementary School
Cullman Middle School
Cullman High School
Current Grade Level
Choose
K
1
2
3
4
5
6
7
8
9
10
11
12
Next
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