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2025-2026 Pleasanton Virtual School Enrollment Form
Serving your family’s educational needs from where you are!
Applicant Information
Student Name
*
First Name
Middle Name
Last Name
Gender
*
Please Select
Male
Female
Date of Birth
*
-
Month
-
Day
Year
Date
Place of Birth
Email
example@gmail.com
Best number to reach the student
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Application Details
Grade Entering
Upload the legal guardian's front of DL
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Enrollment Status
Please Select
Old Student
New Student
Admission Application for:
1st Semester
2nd Semester
Educational Background
Junior High School
Name of School
School Address
Street
Street Address Line 2
Municipality
State / Province
Postal / Zip Code
Year Graduated
Elementary School
Name of School
School Address
Street
Street Address Line 2
Municipality
State / Province
Postal / Zip Code
Year Graduated
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Contact In case of Emergency
Name
*
First Name
Middle Name
Last Name
Mobile Number
*
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Relationship
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Parental Information
Name of Mother/Guardian
*
First Name
Middle Name
Last Name
Employer
Mobile Number
*
Address of Mother/Guardian
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of Father/Guardian
First Name
Middle Name
Last Name
Employer
Mobile Number
Address of Father/Guardian
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Non-Custodial Information-Enter only if a parent does not live in the child's household.
Name
Do we need to mail separate gradecards, etc to the non-custodial parent?
Please Select
Yes
No
Is this student Hispanic/Latino
Please Select
No, not Hispanic/Latina
Yes, Hispanic/Latino
What is the students race?
Please Select
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
What Language/Languages does the student speak/read/write?
What Language/Languages does the parent speak/read/write?
Full Name of Applicant
First Name
Last Name
Legal Parent/Guardian Signature
*
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Pleasanton Virtual School USD 344
Records Release Form
I hereby authorize the following school to send my student's records to Pleasanton Virtual School
Attn: JoVoli Clark, jovoli.clark@usd344.org
Name of previous school
Previous school's phone number
Previous School's
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Send copies of School Records To:
PO Box 480, Pleasanton, KS 66075 or email them to jovoli.clark@usd344.org
List student's full name, grade and DOB
Signature of legal guardian
Printed name of legal guardian
First Name
Last Name
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Thank you for your application.
Please hit submit and someone from PVS will reach out to you soon.
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