Withdraw from Virtual Academy

Please complete the form below if you are a current EVSC student who would like to withdraw from the EVSC Virtual Academy and enroll back in your regular district school. 


Withdraw from EVSC Virtual Academy

Student Full/Legal Name: 

Birthdate:   

Student Address: 

City:    

State:   

Zip Code: 

Home Phone: 

Grade Level: 

Please select your school based on your home address, if known: 

If you do not know what school you should attend, please enter the last school you attended prior to enrolling in the EVSC Virtual Academy: 


Parents/Guardians 1 List parents/guardians living with student (i.e. mom & dad, mom & stepdad, etc.)

Relationship to Student: 

Name 1: 

Phone: 

Workphone: 

Email: 

 

Name 2: 

Phone: 

Workphone: 

Email: 


Parents/Guardian 2  List other parent household, if applicable. (Parents/Guardians not living with student.)

Relationship to Student: 

Name 1:  

Phone: 

Workphone: 

Email: 

 

Name 2: 

Phone: 

Workphone: 

Email: 


Emergency Contacts: 

Contact 1 Name: 

Phone Number: 

Relationship to student: 

 

Emergency Contact 2 Name: 

Phone: 

Relationship to student: 

 

Emergency Contact 3 Name: 

Phone: 

Relationship to student: 

 

Emergency Contact 4 Name: 

Phone: 

Relationship to student: 


Additional Enrollment Questions

1. Is there anyone, by court order, who is not allowed to pick up your student? If so, please list.(School must be provided legal documents in order to enforce if a person listed is a parent.)

Does your student have or receive: 

Is your student currently under expulsion/suspension from another school? 

 


By entering your name below, you confirm that the information shared above is true, correct and to the best of your knowledge. 

Parent Signature:       Date: 

 



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