Virtual Learning Application

Parent Name*
Parent Phone Number*
Parent Email*
Student's Name*
Student's Grade*
Student's School*
Student's Gender*
Does your child have a 504/IEP?*
- Yes
- No
Does your child have any food allergies?*
- Yes
- No
I understand that this Virtual Learning Site does not have staff who have the certifications required of Shelby County Schools to provide the modifications/accommodations of students with special needs.

Upon completion of this form, parents will be contacted regarding Parent Orientation.
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