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Chandler Virtual Academy Request Form
Students Legal Name
*
Student Date of Birth
*
/
Month
/
Day
Year
Date
Current Grade
*
Student Home Address
*
Full Address
Student Phone Number
Format: (000) 000-0000.
1. Parent/Guardian Name
*
2. Parent/Guardian Name
1. Parent/Guardian Phone Number
*
Format: (000) 000-0000.
2. Parent/Guardian Phone Number
Format: (000) 000-0000.
Previous School Name (include City/State)
*
Previous School Phone Number
Format: (000) 000-0000.
Reason for Request: Mark all that apply
*
Credit Recovery
Mental Health
Profession Career Path
Athletic Need
Oversees Assignment
Parent Need
Accelerated Learning
Medical Issue
Currently attending a virtual school online/want to transfer to a local virtual school
Need a short-term or long-term alternative school setting due to current situation
Other
In no less than three sentences, please explain your situation and why you want to attend Chandler Virtual Academy:
*
Submit
Should be Empty: