Virtual Program Application:
Parent or Guardian Name.
Student Date of Birth.
Home Phone Number.
Cell Phone Number.
Parent's address (if different than student).
Last school attended.
Check current grade.
Are you currently receiving or have you ever received special education services? (ED, LD, CD, Section 504)
If "yes", please give an explanation of the nature of the special education services provided in the space below:
What type of virtual program are you interested in?
Complete the following questions by selecting one of the 3 following options:
(1) - Most of the time (2) - Sometimes (3) - Rarely
I am self motivated.
I can manage my time well.
I am capable of self-discipline.
I am able to comprehend what I read.
I am goal oriented. If I set my sights on an end result, I achieve it.
I am confident in my academic abilities.
I do not give up easily, even when confronted with obstacles.
I believe I am responsible for my own education. What I learn is ultimately my responsibility.
I have commuting problems.
I have conflicts with work, athletics or child care and school schedules.
I have access to a computer with an internet connection.
I am willing to try something new.
I am willing to work in a non-structured environment.
I am willing to express my opinion in writing.
I am willing to actively participate in the learning process by doing tasks, projects, etc.
Answer the following questions by selecting either Yes or No.
Does your computer have a fast and reliable internet connection?
Are you comfortable using the internet?
Do you know how to write and send e-mails?
Do you understand material best when it is presended visually? Examples - Pictures, written words, charts, graphs etc.
Do you have enough time each day to commit to studying?
Will your family and friends be supportive of your need for time to study?