Apply for Free Online Classes | My Virtual Academy

Student Name *

First Last

Are you currently enrolled in one of our partnering Michigan school districts? *

Yes

Partner school *

Gender *

Male

Female

Date of Birth *

Student Phone Number *

Secondary Phone Number for Student

Student Email Address *

ZIP Code for Student *

Parent/Guardian Name *

First Last

Parent/Guardian Phone Number *

Parent/Guardian Email Address *

Secondary Phone Number for Parent/Guardian

Applicants will be contacted to provide additional detailed forms for enrollment. We will also need parent and or student ID, proof of residency, verification of their original birth certificate, immunization records, and school transcripts.

Hidden

Is the Student 18 years or older?

Yes

Security Check

Comments

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