Inquire About 9-12 Online Learning
Online Academy Inquiry Form

First Name:

Last Name:

Email Address:

Home Phone:

Address:

City:

State:   Zip:

Preferred contact method:

Student Information:

Birth date:

Grade Level:

How many classes do you want to take?

Is the student currently:
On an IEP On a 504 Plan
Suspended Expelled
Homeschooled None of the above

Has the student ever been:

On an IEP On a 504 Plan
Suspended Expelled
Homeschooled None of the above

Current resident school district:

Current or last school attended:

Is another student in your family already enrolled in CK Online?  Yes  No

Comments:



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