Enrollment Form (2017-2018)
Filling out this survey will submit your information to our Kentwood International Virtual Academy Staff. Upon receiving your information we will begin your enrollment.
Please enter your first and last name.
Please enter the email address you would like to be contacted at regarding this application
Student Phone Number
Parent/Mentor Email Address
Parent Phone Number
What technology access do you have in your home? Check each box that applies
Online Learning Experience
Have you taken an online course before?
Select the statement that best describes your technological compentency
I feel comfortable using technology
I only use technologies that are familiar to me
I avoid using technology
Online courses require you to be a self-motivated, independent learner. You are responsible for your progress and pacing. Select the statement that best describes you as a learner.
I often get my assignments done ahead of time.
I need to be reminded in order to complete assignments on time.
I put things off to the last minute and do not always complete assignments.
Successful online learners communicate often with instructors regarding pacing, content of courses, etc. Please select the statement that best describes you.
I feel comfortable asking questions and asking for help when I need it
I don't often ask questions of the teacher, but I will if I need it.
I don't like to ask questions or ask for help.
In a given week, how much time do you expect to spend studying for one course?
I can dedicate about four to six hours a week for studying
The same amount as attending and studying for a traditional course (5 hours)
Less time than a traditional course since the class does not meet daily.
I do not know what to expect.
I think an online class:
Will be a breeze and easy to complete
May be difficult but I am capable of handling it.
Will be difficult for me and I will need a lot of assistance.
Please state your goals for taking an online course. Let us know why you believe an online course would be a good educational fit for you. Share any background information that you feel is important.
What type of school are you currently attending?
Public School District
How did you hear about KIVA? Check as many boxes that apply.
Current or Previous KIVA student/parent
Website (including Facebook)
Friend or family member
State catalog of online providers
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