Agora Enrollment Forms Packet – Fill Out and Use This PDF

Agora Enrollment Forms Packet – Fill Out and Use This PDF

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Agora Enrollment Forms Packet – Fill Out and Use This PDF

The Agora Enrollment Packet form is a detailed document designed to streamline the enrollment process for new students at Agora Cyber Charter School. It guides parents and guardians through the necessary steps, requiring specific documents to support the application, including proof of age, residency, immunization records, and previous school records, among others. To ensure a smooth transition and compliance with educational regulations, interested parties are encouraged to meticulously review and submit the required documentation.

To begin the enrollment process for your student, kindly ensure you have gathered all the necessary documents listed in the enrollment packet. Click the button below to fill out the form and embark on your journey with Agora Cyber Charter School.

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Agora Enrollment Forms Packet PDF Details

Embarking on the journey of enrolling a student into a cyber charter school involves manifold steps and meticulous documentation, as illustrated by the Agora Enrollment Packet form. This document serves as a pivotal tool for the Agora Cyber Charter School, based in Herndon, VA, to streamline the enrollment process for new students. Potential enrollees are required to furnish a range of documents, from proof of age and residency to health records and former schooling information. Specifically, the packet demands official documentation such as a birth certificate, utility bills or driver’s license for residency proof, and academic records, including report cards and unofficial transcripts. It also delves into more specialized documentation for students with individual education plans (IEPs) or under special education, requesting current evaluations and accommodation plans. Beyond logistical requisites, the packet underscores a commitment to safety and compliance with school policies through the inclusion of forms like the Charter School Student Notification and a statement regarding any history of offenses or suspensions. By meticulously completing this packet, parents and guardians not only affirm their child’s candidacy for Agora Cyber Charter School but also engage in a detailed yet crucial process designed to ensure a smooth and informed transition into cyber schooling.

Question	Answer
Form Name	Agora Enrollment Forms Packet
Form Length	8 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	2 min
Other names	MailInForm agora charter school pittsburgh 866 529 0166 form

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Agora Cyber Charter School

Enrollment Processing Center

2300 Corporate Park Drive

Suite 200

Herndon, VA 20171

Ph. 1.866.548.9451

Fx. 1.866.529.0166

www..k12.com/agora

Enrollment Forms Packet (EFP)

Please review the information below. Based on your student(s) grade and applicable circumstances, you are required to sub- mit documentation in order to complete this step in the enrollment process. You can fax, scan and email, or mail the required paperwork .

Important Note: Please send copies, do not mail the original documents
Fax (preferred):	Scan and Email:		Mail:
1-866-529-0166	agorafax@k12.com		Agora Cyber Charter School
			2300 Corporate Park Drive
			Suite 200
			Herndon, VA 20171

Required For?	Item	Description		Provided
Required For?	Item	Description		by?
				by?

	Proof of Age	Oficial Birth Certiicate (not the hospital issued certiicate)		Provided by
	Proof of Age			you
				you

		Please submit one of the following:
	Proof of Residency	Current Utility Bill (gas, water, electric, sewage, cable or land line phone) with service address OR		Provided by
	Proof of Residency	Valid Pennsylvania Driver’s License OR Department of Transportation ID OR Mortgage statement/		you
				you
		Current Lease with signature OR Valid Vehicle Registration OR Property tax bill OR Deed

	Immunization Record	Current Immunization Record OR Immunization Exemption Form		Provided by
	Immunization Record	Current Immunization Record OR Immunization Exemption Form		you
				you

	Charter School Student	By illing out this form, you have indicated your decision for your child to attend Agora and that		Provided in
	Enrollment Notiica-			Provided in
	Enrollment Notiica-	your child will not be enrolled in another school while attending Agora.		this packet
	tion Form			this packet
Required for all	tion Form

		Please note that you should only write an “X” in one of the blanks to indicate if your student WAS/
Students	Notiication of Offense			Provided in
	Notiication of Offense	IS or WAS/IS not expelled or suspended. Only ill out the boxed section if it applies to your student.		Provided in
	Form			this packet
	Form	The form must be signed and submitted for all students.		this packet
		The form must be signed and submitted for all students.
	Home Language	Please read the directions for this form to ensure you answer the questions correctly		Provided in
	Survey			this packet
	Survey			this packet
	Face-to-Face Enroll-			Provided
	ment Information Ses-	This form serves as conirmation the parent or guardian attended the Face to Face Enrollment Ses-		during
	sion Acknowledgement	sion.		Orientation
	of Attendance			Session
		By illing out this form, you are giving our school permission to request your student’s oficial re-		Provided in
	Release of Records	cords from their previous school after the approval process. If your child is enrolling in Kindergar-		Provided in
	Release of Records			this packet
		ten or was Homeschooled please indicate it on the form, ill out the top portion and sign it.
Required for all 1st	Report Card	Please submit your student’s most recent report card.		Provided by
-9th Grade Students	Report Card	Please submit your student’s most recent report card.		you
-9th Grade Students				you

Required for all 10		You will need to request an unoficial transcript from your student’s current school, which will		Provided by
Required for all 10	Unoficial Transcripts	show your student’s academic standing. This is required in order to place all 10th - 12th graders.		Provided by
-12th Grade Students	Unoficial Transcripts			you
-12th Grade Students		Once your student is approved, we will receive the oficial transcript directly from the school.		you

Required for Prior	Afidavit, Educational	This is the form that you would have iled with the district registering your child as a home		Provided by
Home School Stu-	Objectives and Evalu-			Provided by
Home School Stu-	Objectives and Evalu-	schooled student.		you
dents	ation	schooled student.		you
dents	ation

Required for student	IEP	A copy of your student’s current IEP (Individualized Education Plan). Because the IEP expires		Provided by
Required for student	IEP	yearly, please submit the current IEP.
with an IEP or other		yearly, please submit the current IEP.		you
Special Education	Evaluation Report	The Evaluation Report is valid for 3 years. If you do not have a copy of your student’s ER, you		Provided by
needs	Evaluation Report	can request a copy from your student’s current school.		you
needs		can request a copy from your student’s current school.		you
Required for students	504 Accommodation	A copy of your student’s current 504 Accommodation Plan. Because the 504 expires yearly, please		Provided by
that have a 504 plan	Plan	submit the current 504.		you

Charter School Student Enrollment Notification Form

For School Year 1-1

Warning: A child enrolled in another public school or a nonpublic or private school cannot, at the same time, enroll in a charter school, but is permitted to complete an application for enrollment while enrolled in other school.

Name of Charter

School:		Agora Charter Cyber School
Address:		995 Old Eagle School Road Suite 315
		Wayne, PA 19087
Charter School
Contact Person:		Business Office
			Email
Telephone:	877-362-4672		Address:	enrollment@agora.org

I. Student Information:

Last

First

Name:

MI:

Home

Address:

City:

State:

Zip Code:

County:

Telephone:

Mailing Address (If

Different From

Home Address)

City:

State:

Zip Code:

Date Of Birth:

Age:

II. School District of Residence and Former School Information

School District of

Residence:

Former School Information (Other Than Pre-School):

Public

School

Charter School

Home School

Nonpublic School

Student Not Enrolled in School Preceding Enrollment in Charter School Because:

Entering

Kindergarten

Re-Enrolling Dropout

Other

Name of Former School:

Address of Former School:

Withdrawal Date From Former

Previous Grade:

School:

Was Your Child Receiving Special Education Services Based On An Iep?

Yes

If Yes, Do You Have The Child’s Special Education Records (Iep)?

Yes

Page 1 of Charter School Student Enrollment Notification FormPDE 7/2002 Instructions for this can be found at www.pde.state.pa.us. Under the K-12 Schools folder, click on Public Schools, then Charter School, then Reporting.

III. Parent/Guardian Information:

	Both	Both Parents		Mother	Father
Child Lives With:	Parents	Alternately		Only	Only
	Legal	Foster
	Guardian	Parents	Other Adult
Special Custodial Court Instructions:
(If Yes, Please Provide a Copy of Court
Order.)		Yes	No

Complete Parent/Guardian Name and Address Information As Applicable

Father’s Name

Address:

City:		State:	Zip Code:
Home Telephone:	Work Telephone:
Mother’s Name
Address:
City:		State:	Zip Code:
Home Telephone:	Work Telephone:

If The Student Is Not Living With Parents, Please Complete This Section.


	Guardian’s Name	Or	Foster Parent’s Name		Or		Other Adult Name
Name:
Address:
City:				State:		Zip Code:

My signature on this form indicates my decision to have my child attend the charter school named on page 1 of this form and signifies my request that appropriate school records be forwarded from the school district to the charter school. My signature also certifies that my child is not, and will not be, enrolled in another public school, a nonpublic school or a private school at the same time he or she is enrolled in this charter school.

Signature of

Parent/Guardian:Date:

IV. To Be Completed By Charter School:

Verification of Date of Birth:

Birth Certificate

Other

Proof of

Mortgage

Utility

Residency

Statement

Lease

Bill

Other

Official Enrollment Date:

Anticipated Date of Attendance:

Grade Student Is Entering:

Signature of Charter School

Representative:

Page 2 of Charter School Student Enrollment Notification Form

PDE 7/2002

2300 Corporate Park Drive

Suite 200

Herndon, VA 20171

Toll Free: 877‐36 AGORA (362‐4672)

Office: 610‐254‐8218

Fax: 866‐529‐0166

www.agora.org

NOTIFICATION OF OFFENSE INVOLVING WEAPONS, ALCOHOL OR DRUGS, INFLICTION OF INJURY TO ANOTHER PERSON, OR ANY ACT OF VIOLENCE, COMMITED ON SCHOOL PROPERTY

Parental Registration Statement

Student Name

Agora Virtual Charter School is committed to comply with the Safe Schools Act to ensure the safety and well-being of our students. According to Pennsylvania Act 26 of 1995, “Prior to admission to any school entity, the parent, guardian, or other persons having control or charge of a student shall, upon registration, provide a sworn statement or affirmation stating whether the pupil was previously suspended or expelled from any public or private school of this Commonwealth or any other State for an act or offense involving weapons, alcohol or drugs, or for the willful infliction of injury to another person or any act of violence committed on school property. The registration shall include the name of the school from which the student was expelled or suspended for the above-listed reasons with the dates of expulsion or suspension and shall be maintained as part of the student’s disciplinary record.” In addition, under Act 26 of 1995, “any willful false statement made under this section shall be a misdemeanor of the third degree.”

Please check the appropriate box below and sign: (if you indicate “Yes” please complete the remainder of this form and sign)

I hereby swear or affirm that

YES, My child has been previously suspended or expelled OR currently is suspended or expelled from any public or private school of this Commonwealth or any other state for an act or offense involving weapons, alcohol or drugs, or for the willful infliction of injury to another person or for any act of violence committed on school property.

NO, My child has not been previously suspended or expelled OR currently is suspended or expelled from any public or private school of this Commonwealth or any other state for an act or offense involving weapons, alcohol or drugs, or for the willful infliction of injury to another person or for any act of violence committed on school property.

I make this statement subject to the penalties of 24 P.S. §13-1304-A(b) and 18 Pa. C.S.A. §4904, relating to unsworn falsification to authorities, and the facts contained herein are true and correct to the best of my knowledge, information and belief.

**Please complete if your child has been or is presently suspended or expelled from another school** My child was ฀ suspended ฀ expelled from the following school:

Name of the school: __________________________________________ Telephone:________________________________

School Address:____________________________________________________________________________________________

Suspension/ Expulsion Start Date: _____________________________________ (MM/DD/YYYY)

Suspension/ Expulsion End Date: ______________________________________ (MM/DD/YYYY)

(Please provide additional schools and dates of expulsion or suspension on back of this sheet.)

Reason for suspension/expulsion. (Please check all that apply) o Offense involving weapons

o Offense involving alcohol o Offense involving drugs

o Willful infliction of injury to another person

o An act of violence committed on school property o Other Additional comments:

_________________________________________________________________

(Parent or Guardian Signature)

(Date)

Thank you for completing the following information on the Home Language Survey. This is information the Pennsylvania Department of Education requires be collected by all educational entities during initial enrollment.

The first three questions relate to your child’s first language. Please do not include languages learned in school. As part of the enrollment process, this information will assist us in identifying any supports that your child may need.

Question four asks if your child has attended school in the United States for any three years. These years do not have to be consecutive. Please complete the name of school, state and dates attended for the most current schools your child has attended in the United States. These include preschool, private schools and home schooling.

If someone other than the parent completed the form please note where it indicates. Please leave blank otherwise.

The form is completed by the parent/guardian signing where indicated.

We thank you in advance for taking the time to complete this form.

________________________________________________________________________

HOME LANGUAGE SURVEY*

The Office of Civil Rights (OCR) requires that school districts/charter schools/full day AVTS identify limited English proficient (LEP) students in order to provide appropriate language instructional programs for them. Pennsylvania has selected the Home Language Survey as the method for the identification.

School District:	Date:
School:
Student’s Name:	Grade:

1.What is/was the student’s first language? __________________________

2.Does the student speak a language(s) other than English? (Do not include languages learned in school.)

฀Yes ฀ No

If yes, specify the language(s): ____________________________________

3.What language(s) is/are spoken in your home? ______________________

4.Has the student attended any United States school in any 3 years during his/her lifetime?

฀ Yes ฀ No

Name of School	State	Dates Attended
______________________	_____________	__________________
______________________	_____________	__________________
______________________	_____________	__________________

Person completing this form (if other than parent/guardian): Parent/Guardian signature: ______________________ Date: _____________

*The school district/charter school/full day AVTS has the responsibility under the federal law to serve students who are limited English proficient and need English instructional services. Given this responsibility, the school district/charter school/full day AVTS has the right to ask for the information it needs to identify English Language Learners (ELLs). As part of the responsibility to locate and identify ELLs, the school district/charter school/full day AVTS may conduct screenings or ask for related information about students who are already enrolled in the school as well as from students who enroll in the school district/charter school/full day AVTS in the future.

Agora Cyber Charter School

Enrollment Processing Center

2300 Corporate Park Drive

Suite 200

Herndon, VA 20171

Ph. 1.866.548.9451

Fx. 1.866.529.0166

www..k12.com/agora

Release of Student Records

Please accept this document as formal approval for the release of all official school records (including the record of transcripts, testing information, special education, health and immunization records).

Student Information

Student’s Full Name:

	first		middle	last
Student’s Date of Birth:
Student’s Legal Address:
		street		apt #

city			county	state	zip
Home Phone:

Homeschooled or Never Previously Enrolled in School (Fill out only if applicable)

Check below if applicable:

oStudent was always previously homeschooled

oStudent is enrolling in Kindergarten

Prior School Information

NameofPriorSchool:

School’s Address:

	street
city		county	state	zip
School’s Phone:

Sign and Date below

Name of Parent or Legal Guardian:

	first	last
Parent/Guardian’s Signature:			Date:

SCHOOL OFFICIALS ONLY:

Send student records to: Agora Cyber Charter School
Send student records to:	Virginia Virtual Academy
Send student records to:	995 Old Eagle School Road
Send student records to:	Washington Virtual Academies
	2300 Corporate Park Drive, Suite 200

Suite 315

1584 McNeil Street, Suite 200

Herndon, VA 20171

Wayne, PA 19087

DuPont, WA 98327

Student’s Name:

Student’s Home Phone:

2300 Corporate Park Drive

Suite 200

Herndon, VA 20171

Toll Free: 877-36 AGORA (362-4672)

Office: 610-254-8218

Fax: 866-529-0166

www.agora.org

Acknowwledgment of Legal Guardianship

Student Name: ____________________________________________

Date of Birth___________________________

I understand that false statemennts herein are made subject to the penalties of the crimes code, chapter 49, subchapter A, sections 4901 to 4904, relating to perjury and falsification in official matters.

Please complete ONE of the following:

1.I (We) am the NATURALL parent(s) of the named student. I (We) retain custodial rights to enroll the student in the Agora Cyber Charter School.

Mother Name ___________________________________________________________________

Signature ________________ __________________________ Date______________________

Father Name ___________________________________________________________________

Signature ________________ __________________________ Date______________________

2.I am the court appointed guardian, adoptive parent or foster parent of the named student. I will provide the appropriate documentation to enroll the student in the Agora Cyber Charter School.

•Court Ordered Custoody Agreement

•Adoption Decree

•Verification of Fosteer Care Placement (such as a letter from the appropriaate agency)

•Other Appropriate Legal Documentation

Name________________________________________________

Signature ___________________________________________ Date_____________________

Relationship to student_____________________________________

3.I am the primary care givver of the name student. I will provide the appropriiate documentation to enroll the student in the Agora Cyber Charter School.

•If you are not the leggal guardian of the named student but are supporting the student gratis, (without personal coompensation or gain), will assume all personal obligatiions for the student relative to school re quirements and intend to keep and support the student continuously and not merely through the school term, you are required to submit the Agora Cyber Charter School Sworn and Notarized Statement. Please request this form by contacting 1-866- 548-9452.

Care GiverName_______ ___________________________________________ _______________

Signature ___________________________________________ Date_______________________

Relationship to student_____________________________________

How to Edit Agora Enrollment Forms Packet Online for Free

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Step 1: Select the button "Get Form Here".

Step 2: You're now on the document editing page. You may edit, add text, highlight selected words or phrases, insert crosses or checks, and insert images.

The next areas are what you are going to create to have the ready PDF document.

Agora Enrollment Forms Packet gaps to fill in

Make sure you type in the crucial data in the I Student Information Last Name, City, County Mailing Address If, City, Date Of Birth, First Name, State, Zip Code, Telephone, State, Age, Zip Code, II School District of Residence, Former School Information Other, and Public School field.

stage 2 to filling out Agora Enrollment Forms Packet

The application will request particulars to automatically fill in the area Name of Former School, Address of Former School, Previous Grade, Withdrawal Date From Former School, Was Your Child Receiving Special, Yes, If Yes Do You Have The Childs, Yes, Page of Charter School Student, and PDE.

Entering details in Agora Enrollment Forms Packet stage 3

In section III ParentGuardian Information, Child Lives With, Both Parents Legal Guardian, Both Parents Alternately Foster, Other Adult, Mother Only, Father Only, Special Custodial Court, Yes, Complete ParentGuardian Name and, Fathers Name Address City Home, Mothers Name Address City Home, State, Zip Code, and Work Telephone, state the rights and responsibilities.

part 4 to filling out Agora Enrollment Forms Packet

Finish by taking a look at the next areas and filling them in as needed: Mothers Name Address City Home, State, Zip Code, Work Telephone, If The Student Is Not Living With, Guardians Name Name Address City, Foster Parents Name, Other Adult Name, State, Zip Code, My signature on this form, Signature of ParentGuardian, and Date.

step 5 to filling out Agora Enrollment Forms Packet

Step 3: When you are done, choose the "Done" button to upload your PDF document.

Step 4: Make duplicates of your document. This will prevent possible future difficulties. We do not check or distribute your information, hence be assured it is secure.

Date of Birth

Parent or Guardian Name

_______________

Home Address

__________

Home Phone

Alternate Phone_____

__________________