BVS Application for Enrollment 2017 - 2018

Select Current Grade Level:

Select Enrollment Type (select one):

 

Student Information:

Gender:
First:  
Middle:
Last:  
Birth Date:  
Nickname:
Student Cell #:
Student Email:
Physical Address:  
If mailing address the the same as physical address check the box.
Mailing Address:

Last School Attended

 
School:  
City:  
State:  

Must Select "Yes" or "No" for each item below:

Will an adult be able to devote 30-40 hours per week as the students "Learning Coach"?
 
Does the student have an active IEP or 504 plan?
 
Are you going to be a 12th grader this school year?
 
Do you have a computer and high-speed Internet at home?
 
Has the student ever been suspended from school?
 
Has this student had any previous expulsions, felony arrests resulting in a charge, is pending expulsion, or any juvenile justice actions?
 
"Section 1006.07(1)(b), Florida Statutes and School Board Policy 7.103 require each student at initial registration for school enrollment in the district to report any previous school expulsions, arrests resulting in a charge, and juvenile justice actions the student has had."

Primary Parent/Guardian 1:

Relationship to Student:
Name:  
Address:
If parent address the the same as student address check the box.
Home/Cell #:  
Work #:
Email:

Secondary Parent/Guardian 2:

Relationship to Student:
Name:
Address:
If parent address the the same as student address check the box.
Home/Cell #:
Work #:
Email:

*Please read before electronically signing*

Success as a virtual student requires that you acknowledge the need for daily engagement within courses by maintaining structured pacing where assignments and assessments are completed each day. Regular communication with teachers through email and/or phone calls, attendance at Success Sessions or online classroom sessions, and parent/coach supervision of daily student progress is required. Meeting the conditions within the Bay Virtual School Parent-Student Handbook is required for enrollment.

Electronic Student Signature:
Electronic Parent Signature:

Today's Date:

I have read and understand the requirements of Bay Virtual School and the Student/Parent Handbook.
  
(For your records, PRINT the application before submitting.)