Wichita Public Schools

Learning2 eSchool of Wichita

Student Application

HOW TO COMPLETE THIS APPLICATION

  • Application should be completed by student and/or parent or guardian.
  • We will contact you via phone or mail.

STUDENT INFORMATION

 

 
       
Student Name:
  Last First MI                                Maiden
Student Address:  
  Street Address     City / State Zip Code

 Contact Info:

 

 Last School Attended:

Day Phone (NUMBERS ONLY)

 

Evening Phone (NUMBERS ONLY)

City / State

/

Phone / Fax

       
Name used at Last School Attended (If Different):
Email Address  


Date of Birth MM/DD/YYYY:
Age		  
Grade		 Last First                                            Maiden
Last 4 Digits of SS#:    Gender:        M            F Do you have a GED? Yes             No
(to aid in verifying your transcript)   Have you graduated from a High School?     Yes             No

Are you Hispanic/Latino?      Yes        No

 

Ethnicity:

 Asian      

Native Hawaiian or Other Pacific Islander

White

Black or African-American   

American Indian or Alaskan Native
 

HEALTH
 

Do you have a significant physical condition or health concerns?       Yes:       No

 

 

 

 

 

 

 

SERVICES

 

 

 
 

Do you qualify for any of the following services?

Special Education:    Yes             No

504:   Yes             No

ESOL:    Yes             No

 

 

 

 

PARENT/GUARDIAN INFORMATION

 

 
       
/
Name Relationship Email Address Day Phone / Evening Phone
/
Name Relationship Email Address Day Phone / Evening Phone
/
Name Relationship Email Address Day Phone / Evening Phone
What adult, if any, will be home during the school day with the student?
Email Address
Teaching Adult Name
     

TECHNOLOGY QUESTIONS

 

 

 
     
Do you have Internet at home?     Yes, Cable          Yes, DSL         Yes, Broadband Card (Sprint, Cricket)         Yes, Dial-Up      No, we don't have Internet
 
Will you need to check out a computer from us?  Yes             No
   

INTEREST QUESTIONS

 

 

 
       
What are your plans after you finish school?  
   
What kind of learner are you? Check all that apply:  
See It (Visual) Hear It (Auditory) Hands On (Kinesthetic) Other:
 
Why are you interested in attending a virtual school?