Student Information

Last Name:		First Name
Middle Name:		Student ID Number: (enter NA if non-NNPS)
Date of Birth:
Street Address:
Apt:		City:
State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming	Zipcode:
Parent Email:
Phone Number: (10 digits, no spaces)	- -	Phone Ext:
Daytime Phone: (10 digits, no spaces)	- -	Daytime Phone Ext:
Current School:	-------------- Not an NNPS School (Other) -------------- Denbigh Early Childhood Center Marshall Early Learning Center Watkins Early Childhood Center Ach. Dream Academy Carver Charles Deer Park Discovery STEM Academy Dutrow Stoney Run Gen.Stanford Greenwood Hidenwood Hilton Jenkins Kiln Creek Katherine G. Johnson McIntosh Knollwood Meadows Newsome Park Palmer Richneck Riverside Sanford Saunders Sedgefield Yates	Next Grade (For the 2023-24 school year):	--- PK K 1 2 3 4 5
My student is not currently enrolled in a Newport News Public School. Current School Name: (If Non-NNPS, please email student's academic records to Leah Horrigan-Smith)
Primary reason for enrolling your child in the elementary virtual learning program: Medical Emotional Behavioral Preferred Learning Style
Provide an explanation for the primary reason selected:
Is your child currently receiving services: IEP 504 Unkown

Parent/Guardian Acknowledgements

By entering your initials below, you acknowledge that

• An adult “Learning Coach” will supervise and support your student during live virtual instruction and offline independent learning experiences each school day.
• An adult will supervise and support your student’s virtual learning experience by establishing a Canvas Observer account, actively monitoring ParentVue, and responding to all VLA email communication in a timely manner.
• You and your student will attend an in-person Open House and in-person VLA Orientation Workshop.
• Your student will be required to attend in-person state testing and weekly in-person academic support.

Parent Name:

Non-resident NNPS employee with a child(ren) applying for tuition waiver

Parent Signature (Type Initials):

*Upon successful submission of your Virtual Learning Program application a "Thank you for your registration" page will appear.