Horizons Virtual Academy Application Form
For students in grades 6-12 only
Student Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Age
Student Email
example@example.com
Student Phone Number
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Grade/Level
Reason your student would like to attend the GCCS Horizons Virtual Academy.
Virtual Equipment Checklist
Rows
Issued from GCCS
GCCS Chromebook
Webcam enabled on Chromebook
Virtual Equipment Required, but not provided by GCCS
Rows
Student already owns this equipment
Parents will purchase this equipment
Family may need assistance obtaining
Earbuds
Microphone
Internet Service
Is there anything else you'd like to tell us about your student?
Parent/Guardian/Learning Coach Details
Parent/Guardian Name
First Name
Last Name
Relationship
(Father, Mother, Guardian, etc.)
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Parent's Email Address
example@example.com
Learning Coach
First Name
Last Name
Relationship
(Father, Mother, Guardian, etc.)
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Acknowledgment
I understand that my child will be interviewed, but may not be selected at this time to enroll into the GCCS Virtual Academy, due to enrollment cap set forth for the 2021-22 school year.
I acknowledge that if my child is selected he/she will be participating in a virtual or distance learning.
I understand that I will read the student handbooks in PDF format given by the school administrators and abide by it.
I confirm that I will attend the online school orientation.
I confirm that we (parents/guardians) will be responsible for providing the equipment needed for virtual or distance learning that is not otherwise provided by GCCS.
I accept that all activities, works, and exams will be graded.
Date Signed
-
Month
-
Day
Year
Date
Parent Signature
Date Signed
-
Month
-
Day
Year
Date
Student Signature
Apply
Should be Empty: