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Virtual Learning Academy

Take the First Step. Contact Us.

Forms

Required

CONTACT INFORMATION
Parent/Guardian Namerequired
First Name
Last Name
Phone Numberrequired
Email Addressrequired
Addressrequired
Cityrequired
Ziprequired
STUDENT INFORMATION
Student Namerequired
First Name
Last Name
Date of Birthrequired
Must contain a date in M/D/YYYY format
Agerequired
Graderequired
Last school attendedrequired
Second, to the last school attended
Number of estimated credits earned
Last day attended
Must contain a date in M/D/YYYY format
Do you live in St. Clair County?
Do you have a probation officer?
If yes, include the probation officer's name
Do you have computer and Internet access at home?
Do you have a driver's license?
Do you have any special services?