Information Change Request

Information Change Request

Additional questions will populate as you answer what you are requesting. Form must be completed by Legal Guardian.
Student(s) Full Name *
First & Last Name(s)
Are you changing/adding a Learning Coach? *

Yes No
Are you changing an address? *

Yes No
Are you changing a phone number? *

Yes No
Are you changing an email address? *

Yes No
AZVA/ ISAZ will assign a teacher for your student. In addition, the school program requires that you specify an adult to have the primary responsibility for working with your student on a daily basis (Learning Coach - LC). The primary adult may be a parent, legal guardian, or someone else of your choosing.

We suggest that students have 1 Learning Coach assigned. If multiple learning coaches are assigned the system can not guarantee which LC will receive communication.
Learning Coach (LC) Name: *
LC Relationship to student: *
LC Home Phone: *
LC Alternate Phone:
LC Email: *
example@example.com
Are you adding an additional LC or replacing the current one? *

Replace the currently assigned LC with the person listed above. Add the person listed above as an additional LC. I have read and understand there is not a systematic way to ensure one LC or the other, or both receive all communication. The LC's will communication with each other.
Which Address(es) would you like updated in our system? (Please check all that apply, only those selected will be updated) *

Students Mailing Address Students Shipping Address Students Physical Address (Must attach new proof of residency) Legal Guardian Address Learning Coach Address
New Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Select which New Proof of Residency you will attach. Please note, if you are Re-Registering, you will need to upload a Proof of Residency into your parent portal for the Enrollment Center
Have a Document to Upload? Upload here:

Upload File

Cancel of
Who's Phone Number is being updated? *
New Phone Number *

Area Code Phone Number
Who's Email Address is being updated? *
Email *
example@example.com
Please type any additional notes that will help us complete your request:
I certify that I am the legal guardian for the above student(s) and I am signing in acknowledgement that the above changes will be made for the named students. If the student is over the age of 18 the student is their own legal guardian. *

Yes
Name of person completing this form: *

First Name Last Name
Phone Number (If there are questions about this form) *

Area Code Phone Number
Signature *

Clear
Should be Empty: