Interested in becoming a student at Virtual High School? Please fill out the following form to start the process. Please remember to consult your home school counselor before form submittal. DO NOT withdraw from your home school until you are OFFICIALLY regestered at Virtual HS. Submittal of this form is just the first step in a process toward possible enrollment, but there is NO GUARANTEE of acceptance

I intend to enroll at Virtual HS as a . . . Full-time Student Part-time Student
First Name:		MI:
Last Name:		Student Number:
Birthdate (mm/dd/year):		Home Phone:
Address:
City:		Zip Code:
Email Address:		Home School:
Highest Grade Completed:	8th      9th      10th      11th      12th
Do you have a computer? Yes No
Do you have internet access? Yes No

Letter of Intent Please write a letter below explaining why you think you will be
successful at the Virtual High School. Please include your reason for applying.

How did you hear about the CCSD Virtual High School?
	Counselor		The View Newspaper Ad
	Friend		Website
	Teacher		Other:

Core Classes: Place the name of the core courses you are currently enrolled in or the last classes you have taken in the following subjects. In addition, please indicate your current grade or the grade you received in each class.

English:		Grade:
Mathematics:		Grade:
Science:		Grade:
Social Studies:		Grade:
How many high school credits have you earned?

Please indicate your status on the following Nevada High School Proficiency Exams:

Mathematics:	Pass     Fail      Have not taken
Writing:	Pass     Fail      Have not taken
Reading:	Pass     Fail      Have not taken

If students are not on track for graduation, an alternative placement will be recommended to help students to be more successful.

Comments and/or Questions:

I hereby state ...

I agree that submittal of this Virtual HS Interest Form does not automatically enroll or guarantee me future enrollment at Virtual HS Yes No

I agree that I am NOT TO WITHDRAW from my home school until I am officially enrolled at Virtual HS Yes No

I met with my home school counselor (enter name) on (date)

My legal parent/guardian has granted me permission to attend Virtual HS for Summer, 2008 Yes No

Parent/Guardian name email and phone  

Please type your student number (type "CCSD NEW" if not sure) and full name below to certify the information entered herein.

CCSD Student Number & Full or Part time . .. . . . .Full Name (Last, First)

(Example 1: 1234567 Full-time . . . Example 2: 7654321 Part-time)