Chestnut Ridge Virtual Academy Student Application K-4
Student First Name *
Your answer
Student Last Name *
Your answer
Are you currently enrolled in the Chestnut Ridge School District
If you answered no to the previous question, what school district are you currently enrolled in
Your answer
Student ID#
This is also you lunch #
Your answer
Grade Level for 2017-2018 School Year
Does the student have an IEP (Individualized Education Program)
Please indicate your registration status
Do you have high speed internet access at home?
Would you be in need of a district issued laptop?
Is a parent or guardian at home throughout the school day?
Parent/ Guardian Contact Information
Primary Parent/Guardian Full Name *
Your answer
Primary Parent/Guardian Home Phone *
Your answer
Primary Parent/Guardian Cell Number *
Your answer
Primary Parent/Guardian Email *
Your answer
Electronic Signing
Student Signature- acknowledges that you have read and will abide by the terms as outlined on the district website. *
Required
Parent/Guardian Signature- acknowledges that you have read and will abide by the terms as outlined on the district website. *
Required
Submit
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