DeKalb Virtual Academy Application 2017-18
Please complete the following application for DeKalb Virtual Academy. All fields must be completed to be considered for admission. An application must be submitted for each student.
Student's First Name
Your answer
Student's Middle Name
Your answer
Student's Last Name
Your answer
Date of Birth
MM
/
DD
/
YYYY
Physical Address
Your answer
Is this the Guardian's address?
First Name
Your answer
Last Name
Your answer
Home Phone Number
Your answer
Cell Phone Number
Your answer
Email Address
Your answer
Current School
Your answer
City & State
Your answer
Grade Level for the 2017-18 School Year
Is the student an athlete? Check all that apply.
Required
Are you wanting to be a full-time or blended virtual student?
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.
Required
Is transportation available, by a guardian, for the student to attend meetings on campus weekly or as needed?
Why would you like to become a virtual student?
Your answer
Other Information to Share:
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