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FALL 2008 FULL-TIME STUDENT INFORMATION
Interested in becoming a student at Virtual High School? Please fill out the following form to start the process. Please remember to consult your home school counselor before form submittal. DO NOT withdraw from your home school until you are OFFICIALLY registered at Virtual HS. Submittal of this form is just the first step in a process toward possible enrollment, but there is NO GUARANTEE of acceptance.
First Name: 
Middle Initial:
Last Name:
Student Number:
(Must be 7 digits - use leading zeros)
Birthdate (mm/dd/year):
Phone
xxx-xxx-xxxx:
Address:
City: 
Zip Code:
Email Address:
Home School:
Current Grade: 
8th      9th      10th      11th      12th
Do you have a computer? Yes No
Do you have internet access? Yes No
Letter of Intent Please write a letter below explaining why you think you will be
successful at the Virtual High School. Please include your reason for applying.
How did you hear about the CCSD Virtual High School?
Counselor
The View Newspaper Ad
Friend
Website
Teacher
Other:

Core Classes: Place the name of the core courses you are currently enrolled in or the last classes you have taken in the following subjects. In addition, please indicate your current grade or the grade you received in each class.

English:  Grade:
Mathematics: Grade:
Science: Grade:
Social Studies: Grade:
How many high school credits have you earned? 

Please indicate your status on the following Nevada High School Proficiency Exams:

Mathematics:  Pass     Fail      Have not taken   
Writing:  Pass     Fail      Have not taken   
Reading:  Pass     Fail      Have not taken   

If students are not on track for graduation, an alternative placement will be recommended to help students to be more successful.

Comments and/or Questions:

I hereby state ...

I have consulted with my home school counselor and have been advised that this is the correct course required for CCSD high school graduation Yes No

I agree that I am NOT TO WITHDRAW from my home school until I am officially enrolled at Virtual HS Yes No

My legal parent/guardian has granted me permission to attend Virtual HS for Fall, 2008 Yes No

Parent/Guardian name email and phone

Please type your student number (type "CCSD NEW" if not sure) and full name below to certify the information entered herein.


CCSD Student Number ..... Full Name (Last, First)