Piedmont Virtual Academy Application 2020-21
Please complete one application for each individual student. Deadline to complete application is 12:00 am July 24th, 2020.
Student Last Name *
Student First Name *
Student Street Address *
City, State, and Zip Code *
Student Phone Number
Student email address
Parent/Guardian Last Name *
Parent/Guardian First Name *
Parent/Guardian phone number *
Parent/ Guardian email address *
School *
Grade Level 2020-21 *
Diploma Type (PHS students only)
Clear selection
Does the Student have an IEP or 504 Plan? *
Does the student have access to reliable Internet? *
Today's Date *
I agree to follow all procedures adopted by Piedmont City School System pertaining to Virtual School. (Parent/Guardian Signature) *
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