Archdiocese of Miami Virtual Catholic School (ADOM-VCS)
Email any questions or concerns to Ms. Rebeca Bautista, principal, at principal@adomvirtual.com.

Thank you for your ongoing support of Catholic education.
Enrollment Form: Spring 2020
Is this your first time taking a course with ADOM-VCS? *
STUDENT Last Name *
Last Name will be used to create student account; username will be created, based on information included here.
Your answer
STUDENT First Name *
First Name will be used to create student account; username will be created, based on information included here.
Your answer
Current Grade *
Requested Start Date (earliest possible date is 01/07/2020) *
MM
/
DD
/
YYYY
Requested End Date (latest possible date is 05/15/2020) *
MM
/
DD
/
YYYY
Student Type: *
Name of current school: *
If Home School, enter the name of the curriculum provider/group or district.
Your answer
E-mail Address - Student *
Your answer
Date of Birth - Student *
MM
/
DD
/
YYYY
Gender - Student *
Birth Country - Student *
Your answer
Primary Language - Student *
Your answer
Social Security Number - Student *
SSN is used for identification purposes only - if you do not wish to share SSN, the student's date of birth will be used in a situation where a unique student identifier is requested. Enter either SSN or date of birth
Your answer
Mailing Address - Student *
Only street address - city, state, zip code are separate entries.
Your answer
Mailing Address - Student *
City
Your answer
Mailing Address - Student *
State - two letter abbreviation
Your answer
Mailing Address - Student *
Zip Code
Your answer
Race - Student *
Mark all that apply - at least one is required.
Required
Are you, the student, a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish Culture or origin, regardless of Race? *
Required by Florida Department of Education and Archdiocese of Miami
Religion - Student *
Parent/Guardian Information
Enter "NA" if no information is available.
Parent/Guardian 1: *
PARENT/GUARDIAN 1 Last Name *
Last Name will be used to create student account; username will be created, based on information included here.
Your answer
PARENT/GUARDIAN 1 First Name *
First Name will be used to create student account; username will be created, based on information included here.
Your answer
Parent /Guardian 1 Email *
Your answer
Parent/Guardian 1 Primary Contact Number *
Your answer
Parent/Guardian 2: *
PARENT/GUARDIAN 2 Last Name *
Last Name will be used to create student account; username will be created, based on information included here.
Your answer
PARENT/GUARDIAN 2 First Name *
First Name will be used to create student account; username will be created, based on information included here.
Your answer
Parent /Guardian 2 Email *
Enter 'N/A' if student only has one primary parent/guardian.
Your answer
Parent/Guardian 2 Primary Contact Number *
Enter 'N/A' if student only has one primary parent/guardian.
Your answer
Courses for Spring 2020 - push 'ENTER' after each course name - *
Example: Algebra I S1, English III S2, Economics, World History H S1
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Archdiocese of Miami Virtual Catholic School. Report Abuse