Jackson County Virtual Program Application 2020-2021
Please complete the following application for the Jackson County Virtual Program. All fields must be completed in order to be considered for this program. An application must be submitted for each student. Please contact Kevin McBride, Virtual Program Coordinator for additional information. Contact information: mcbridek@jacksonk12.org or 256 259-9500.
Email address *
Student's First Name *
Student's Middle Name *
Student's Last Name *
Date of Birth *
Physical Address *
Is this the Guardian's address? *
Parent/Guardian's First Name *
Parent/Guardian's Last Name *
Phone Number #1 *
Phone Number #2 *
Email Address *
Currently enrolled in what school? *
City & State *
Grade Level for the 2019-2020 School Year *
Have you been identified with Dyslexia? *
Are you served under a 504 plan? *
Are you served under an IEP? *
Have you had a Truancy referral or warning? *
Do you have a copy of your transcripts? *
Do you have a pending discipline issue or due process hearing? *
Do you have high-speed internet at your home? *
What kind of devices do you have at home? Check all that apply. *
Is transportation available, by a guardian, for the student to attend meetings at a Jackson County campus weekly and as required? *
Reasons for wanting to enroll in the Virtual School Program: *
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