PLA WV - Online Student 2026-2027

Online New Student Registration 2026–2027

Welcome to Phalen Leadership Academy West Virginia. Please follow these steps to continue
1. Select "Next" on this page, and enter the information requested by the online forms. Required fields are marked as "Required". Please be careful of spelling, capitalization, and punctuation.

2. On the "Review & Submit" page, check your data.

3. Select "Submit"! On the submission confirmation page, you will have the opportunity to print out a copy of your registration for your records. Once the form is electronically submitted, you will receive an email confirmation.

New Student Registration 2026 - 2027 for Additional Students

A New Student Registration 2026 - 2027 form must be submitted for each student in your family. Once you have successfully submitted one New Student Registration 2026 - 2027, you will have the opportunity to begin another from the "Submission Confirmation" page.
Student Information
Student ID
Current Status
Full Name*

First NameMiddle NameLast Name
Suffix
Gender*
Date of Birth*

MonthDayYear
Date
Enrolling Grade*
Enrolling School*
School Type*
Home/Residential Information
Home Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Address (where the student resides)*
Apt / Unit / Ste
City*
State*
Zip Code*
New Student Information
Country of Birth*
City of Birth*
District of Residence (In which district does the student reside?)
Ethnicity and Race Report

This form is to be lled out by the student's parents or guardians, and both questions MUST beanswered. Part A asks about the student's ethnicity and Part B asks about the student's race.
Part A - Ethnicity
Is the student Hispanic / Latino?*
A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
Part B - Race
- American Indian or Alaskan Native: A person having origins in any of the original peoples of North and South America including Central America, and who maintains a tribal a liation or a community attachment.
- Black or African American: A person having origins in any of the black racial groups in Africa.
- Native Hawaiian or other Paci c Islander: A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Paci c Islands.
- White: A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
Race(s) – Choose one or more that apply to the student:*

American Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or Other Pacific IslanderWhiteOther
Previous School Information
Has this student ever attended school before?*
Did the student attend pre-school?*
Has the student previously attended a PLA school?*
Last school entry date*

MonthDayYear
Date
Has the student ever been expelled from school?*

YesNo
Has the student ever been suspended from school?*

YesNo
In West Virginia, a school cannot automatically deny enrollment solely because a student was suspended or expelled from a previous school; however, state law requires parents to disclose the student’s current suspension or expulsion status, and schools must verify that information through the West Virginia Education Information System (WVEIS). Under W. Va. Code § 18‑5‑15f, if a student is presently suspended or expelled—particularly for offenses listed in § 18A‑5‑1a—the school district may lawfully refuse admission until the disciplinary period has ended. The school district can also consider the student's disciplinary history when deciding whether to accept enrollment, and may choose to deny admission if the suspension indicates potential behavioral issues that could disrupt the learning environment. Additionally, if a parent fails to provide the required sworn statement about the student’s disciplinary status, or if the student does not comply with the terms and conditions of enrollment, the district may decline to enroll the student consistent with state statute and local board policy.
Parent Education Level*

Graduate school/post graduate trainingCollege GraduateSome CollegeHigh School GraduateNot a High School GraduateDeclined to State
Special Education Information
Check any of the areas of Special Education in which your child was placed in your child's former district of attendance so we can obtain immediate certification of your child's continued rights to these benefits in our own school district.
Has your child ever received any Special Education services?*
Work Survey
The Parent Employment Survey (PES) provides supplemental education and support services to eligible children through national funding. The purpose of the program is to ensure that all migrant students reach the academic standards and graduate with a high school diploma (or complete GED/HSE).

Thank you for answering the following questions. If your child is eligible for the Migrant Education Program, they may receive additional educational support. This information is strictly confidential
Within the last 3 years, have your children moved for any reason?*
Has anyone in your household moved from one school district to another within the United States, to look for seasonal or temporary work in agriculture?*
Is anyone in your household ages 16 and up in need of Job Assistance?
Are you currently receiving Snap benefits?
Education for Homeless Children and Youth - West Virginia McKinney‑Vento Homeless Education Program
The answer you give below will help the district determine what services you or your child may be able to receive under the McKinney-Vento Act. Scholars who are protected under the McKinney-Vento Act are entitled to immediate enrollment in school even if they don’t have the documents normally needed, such as proof of residency, school records, immunization records, or birth certi cate. Scholars who are protected under the McKinney-Vento Act may also be entitled to free transportation and other services.
Where is the scholar currently living?*
I acknowledge that I have received and understand the above rights.*
Does the family qualify for Free and Reduced Lunch?*
Within the last 3 years, have your children moved for any reason?*
Has anyone in your household moved from one school district to another within the United States, to look for seasonal or temporary work in agriculture?*
Emergency Contact Information

Please provide emergency contacts in the order they should be reached in case of an emergency.
Parent Contact 1
Parent Contact 1 ID
Title
Name*

First NameMiddle NameLast Name
Gender

MaleFemaleOther
Relationship to Student*
Emergency Contact?

YesNo
Has custody?*

YesNo
Can pick up student?*

YesNo
Live with student?*

YesNo
Reside at*

YesNo
Parent Contact 1 Phone Information
Phone 1 Number
Please enter a valid phone number.Format: (000) 000-0000.
Phone 1 Type
Preferred phone number?

YesNo
Phone 2 Number
Please enter a valid phone number.Format: (000) 000-0000.
Phone 2 Type
Is this the preferred phone number?

YesNo
Phone 3 Number
Please enter a valid phone number.Format: (000) 000-0000.
Phone 3 Type
Is this the preferred phone number?

YesNo
Employer
ID
Title
Full Name

First NameMiddle NameLast Name
Suffix
Gender

MaleFemaleOther
Relationship to Student
Can pick up student?

YesNo
Lives with student?

YesNo
Reside at?

YesNo
Emergency Contact 2 Phone Information
Phone 1 Number
Please enter a valid phone number.Format: (000) 000-0000.
Phone 1 Type
Phone 2 Number

YesNo
Phone 2 Type
Is this the preferred phone number?

YesNo
Phone 3 Number
Please enter a valid phone number.Format: (000) 000-0000.
Phone 3 Type
Is this the preferred phone number?

YesNo
Employer
Email Address
example@example.com
Additional Contact
Would you like to add another contact?

YesNo
Contact Priority

.
To adjust the priority in which contacts will be called, please select the appropriate order number next to the name.
Contact 1 Priority*
Contact 2 Priority*
Contact 3 Priority*
Siblings
How many school aged siblings does the student have?*
Student Medical Information Form
Physician Name*
Physician Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Dentist
Dentist Name*
Dentist Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Insurance
Do you have health insurance?*
Health Problems
Health Problems (Check all that apply. If none, please check 'None')*

DiabetesSeizure DisorderHeart ProblemsPhysical RestrictionsDiet RestrictionsAllergiesOther illness/disability/special needs/medicationsNone
Current Medication(s) Required at School
Does your student take any medication at school?*
Emergency Authorization
In the event I/we cannot be reached during an emergency, I/we authorize a representative of the school to obtain any necessary medical, dental, hospital, or surgical care for the above‑named scholar.

I certify that the information provided is accurate and understand that it is my responsibility to notify the school of any changes to residency, phone numbers, or emergency contacts.
I have read and agree to the terms of the policy.*
Documents
How would you like to submit a Copy of Parent/Guardian's Driver's License?*
Upload Copy of Parent/Guardian's Driver's License

Cancelof
How would you like to submit your Proof of Residence?*
Upload your Proof of Residence

Cancelof
How would you like to submit your Scholar's Birth Certificate?*
Upload your Scholar's Birth Certificate

Cancelof
How would you like to submit your Scholar's Immunization records?
Upload your Scholar's Immunization records

Cancelof
How would you like to submit your Scholar's IEP/504?
Upload your Scholar's IEP/504

Cancelof
How would you like to submit your Scholar's Behavior Records?
Upload your Scholar's Behavior Records

Cancelof
Agreements
Chromebook/Mobile Device Student User & Parental Agreement Form
Please read the Chromebook/Mobile Device Student User & Parental Agreement Form
Chromebook/Mobile Device Student User & Parental Agreement*
I have read and agree to the terms of the policy.
Dress Code Policy Acknowledgment*
I have read and agree to the terms of the policy.
Parent Compact Acknowledgment
Click to open Parent Compact Form Document PDF
Parent Compact Acknowledgment*
I have read and agree to the terms of the policy.
School Messenger Consent
Click to open School Messenger Form Document PDF
School Messenger Consent*
I have read and agree to the terms of the policy.
Ferpa Consent Form
Click to open Ferpa Consent Document PDF
I hereby Ferpa consent form*
CHIRP Parent Consent
Click to open CHIRP Parent Consent Document PDF
I hereby consent to the release of such information.*
Media Release Policy Acknowledgment
Click to open Media Release PDF
Media Release Policy Acknowledgment*

I give my consent to the Media Release Policy.I do NOT give my consent to the Media Release Policy.
Preferred Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Secondary Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
Guardian First Name
Parent/Guardian Signature*
How Did You Hear About Us?
In an attempt to track how our families came to apply, we'd like to add this question to our application prior to the Signature tab and include the following:
How did you hear about us? Please check all that apply.

Postcard or FlyerRadioTelevisionReferralSocial MediaWebsiteGoogleBillboardApp AdvertisementEmailTextSchool RepresentativeOther
Electronic Signature
The electronic signature, and all of its related fields, replaces a handwritten signature on paper and is legally binding.

I affirm that the information provided is true, correct and complete, to the best of my knowledge and belief. This electronic signature below and its related fields are treated like a handwritten signature on a paper form.
Do you agree to the above statement?*
Electronic Signature (type name of parent/guardian)*
Today's Date (mm/dd/yyyy)*

MonthDayYear
Date
Correspondence Email*
example@example.com
Should be Empty:

Online New Student Registration 2026–2027

Student Information

Home/Residential Information

New Student Information

Ethnicity and Race Report

Part A - Ethnicity

Part B - Race

Previous School Information

Special Education Information

Work Survey

Education for Homeless Children and Youth - West Virginia McKinney‑Vento Homeless Education Program

Emergency Contact Information

Parent Contact 1

Parent Contact 1 Phone Information

Emergency Contact 2 Phone Information

Additional Contact

Contact Priority

Siblings

Student Medical Information Form

Dentist

Insurance

Health Problems

Current Medication(s) Required at School

Emergency Authorization

Documents

Agreements

Chromebook/Mobile Device Student User & Parental Agreement Form

Parent Compact Acknowledgment

School Messenger Consent

Ferpa Consent Form

CHIRP Parent Consent

Media Release Policy Acknowledgment

How Did You Hear About Us?

Electronic Signature