iHigh Virtual Academy

Full Time Student Application Process: STEP 4 (ENROLLMENT FORM 2009-10)

Please complete the form below. Mandatory fields marked *

I. Student Information
Last name (LEGAL NAME ONLY) *
First *
Middle *
(Jr, II, III)
Nickname *
Other name(s) used previously (AKA) *
Birth date *
Student Social Security Number *
Gender * M F
Is student Hispanic or Latino? * Yes No
Race (select one or more):
Black or African American White Cambodian Chinese Filipino Japanese Laotian Vietnamese
American Indian or Alaska Native Asian Indian Guamanian Hawaiian Hmong Korean Other Asian
Other Pacific Islander Tahitian Samoan
Home Phone *
Household address *
City *
State *
ZIP Code *
Mailing address *
City *
State *
ZIP Code *
City & State of birth *
Country of birth *
First enrolled in a CA school (K-12 only) Date *
First enrolled in a US school (K-12 only)Date *
Student residential status (check one):
Parent/legal guardian (home) Foster Family Home (FFH) Foster Group Home (FGH)(FFA)
Homelessness-doubling up (living with someone) * Homelessness-hotel/motel * Homelessness-sheltered *
Homelessness-unsheltered * Hospital (not state hospital) Incarcerated institution Residential facility
Other:
* Temporary Residence due to financial hardship
II. Sibling Information
Complete this section only if applicable. Include only siblings who are currently in Grades PK-12 in SDUSD.
Sibling 1 full name
Grade
School Name
Sibling 2 full name
Grade
School Name
Sibling 3 full name
Grade
School Name
III. Contact Information
Please complete this entire section. You must provide information for three contacts. For additional contacts, use the Notes section on the next page.

Education levels: NHS = Not a high school grad HS = High school grad SC = Some college/AA degree C = College grad G = Graduate/Post grad DEC = Decline to state

Flags: RC = Report card copy PR = Progress report copy INT = Interpreter needed OK = OK to release student PC = ParentConnection access AM = Active Military
PARENT/GUARDIAN
Contact full name *
Lives with student? * Yes No
Other
Home phone *
Work phone
Cell phone
Email address *
Employer *
Contact Primary Language *
Education level * NHS HS SC C G DEC
Flags (check all that apply) * INT PC AM
OTHER OTHER PARENT/GUARDIAN
Contact full name *
Lives with student? * Yes No
Other
Home phone *
Work phone
Cell phone
Email address *
Employer *
Contact Primary Language *
Education level * NHS HS SC C G DEC
Flags (check all that apply) * INT PC AM
EMERGENCY CONTACT (OTHER THAN PARENT)
Contact full name *
Home phone *
Work phone
Cell phone
Contact Primary Language *
Flags (check all that apply) * INT PC AM
IV. QUESTIONS FOR PARENT/GUARDIAN
Has your child ever received Special Education services? * Yes No
Have you now engaged in migrant work, or have you been engaged in migrant work (moved and worked seasonally in agricultural, lumber or fishery related jobs) in the last three years? * Yes No
Do you want your child's information to be unlisted in the school directory?* Yes No
Do you want the primary contact's email address to be included in the student information system? * Yes No
(For high school students only) Has your child ever played interscholastic athletics? * Yes No
(For high school students only) Is it okay to release your child's information to military recruiters? * Yes No
(For students born outside the U.S.-see #15) Was this student born in a foreign country to diplomatic, military personnel or other U.S. citizen and granted U.S. citizenship? * Yes No
Additional Information:

* The information provided in Sections I-IV is true to the best of my knowledge.

* Be sure you have finished Steps 1,2,3 and 4 as well. Your application will not be considered until all three Steps are completed.

iHigh Virtual Academy

I. Student Information

II. Sibling Information

III. Contact Information

IV. QUESTIONS FOR PARENT/GUARDIAN