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Enrolling 3 Students
ESVCA Enrollment Application (3)
Parent/Legal Guardian Section
This section should be completed by the parent/legal guardian acting as the primary point of contact for Eschool Virtual Charter Academy.
Parent/Legal Guardian Name
(Required)
First
Last
Please list the name of the parent/guardian who is the primary point of contact for the student being enrolled.
Parent/Legal Guardian Gender
(Required)
Female
Male
Relationship To Student
(Required)
Mother, Natural/Adoptive
Mother, Step
Father, Natural/Adoptive
Father, Step
Grandmother
Grandfather
Court Appointed Guardian
Parent/Legal Guardian Phone
(Required)
Parent/Legal Guardian Email
(Required)
Parent/Legal Guardian Date Of Birth
(Required)
MM slash DD slash YYYY
Preferred Form of Contact
(Required)
Text Message
Phone Call
Email
Parent/Legal Guardian Household Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
The student’s family must have a legal residence in the state of Oklahoma in order to attend public school. Please list the legal Oklahoma residence at which the student resides.
Is the parent/legal guardian a member of the active uniformed military services of the United States and on full time active-duty status or active-duty orders?
(Required)
Yes
No
Has this person, within the past 36 months, relocated with the intent to obtain seasonal or temporary employment in agriculture, fishing, and dairy of food processing work?
(Required)
Yes
No
Emergency Contact
Please list the name and phone number of someone, other than you, that can be reached in the event of an emergency.
Emergency Contact Name
(Required)
First
Last
Emergency Contact Gender
(Required)
Female
Male
Emergency Contact Phone Number
(Required)
Which of the following most accurately describes the emergency contact's relationship to the student(s).
(Required)
Family Friend
Family Member
Father, Step
Grandfather
Grandmother
Mother, Step
Student Section
Student 1 Name
(Required)
First
Last
Gender (As shown on birth certificate)
(Required)
Male
Female
Previous School District Attended (Ex. Conway Public Schools)
(Required)
Site Name of Previous School (Ex. Conway Elementary Schools)
(Required)
County of Previous School (Ex. Lincoln County)
(Required)
Student 1 Birth Date
(Required)
MM slash DD slash YYYY
Student 1 Birth City
(Required)
Student 1 Birth State
(Required)
2024-2025 Grade
(Required)
K
1
2
3
4
5
6
7
8
9
10
11
12
Is Student 1 Hispanic or Latino
(Required)
Yes
No
Race: How does Student 1 Identify?
(Required)
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Student 2 Name
(Required)
First
Last
Gender (As shown on birth certificate)
(Required)
Male
Female
Previous School District Attended (Ex. Conway Public Schools)
(Required)
Site Name of Previous School (Ex. Conway Elementary School)
(Required)
County of Previous School (Ex. Lincoln County)
(Required)
Student 2 Birth Date
(Required)
MM slash DD slash YYYY
Student 2 Birth City
(Required)
Student 2 Birth State
(Required)
2024-2025 Grade
(Required)
K
1
2
3
4
5
6
7
8
9
10
11
12
Is Student 2 Hispanic or Latino
(Required)
Yes
No
Race: How does Student 2 Identify?
(Required)
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Student 3 Name
(Required)
First
Last
Gender (As shown on birth certificate)
(Required)
Male
Female
Previous School District Attended (Ex. Conway Public Schools)
(Required)
Site Name of Previous School (Ex. Conway Elementary School)
(Required)
County of Previous School (Ex. Lincoln County)
(Required)
Student 3 Birth Date
(Required)
MM slash DD slash YYYY
Student 3 Birth City
(Required)
Student 3 Birth State
(Required)
2024-2025 Grade
(Required)
K
1
2
3
4
5
6
7
8
9
10
11
12
Is Student 3 Hispanic or Latino
(Required)
Yes
No
Race: How does Student 3 Identify?
(Required)
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Are any of the above listed students being served on an Individualized Education Program (IEP)?
(Required)
Yes
No
If you answer yes to the above question, please list the name(s) of student(s) that are being served on an Individualized Education Plan.
Add
Remove
Consent
Consent
(Required)
By checking this box, I am acknowledging that I am the parent/legal guardian of the student(s) listed above. I understand that I am enrolling my child/children at Eschool Virtual Charter Academy; a free, online, public school in the State of Oklahoma. In addition, I agree to allow the ESVCA enrollment team to enter the above information into the ESVCA student information system for processing, enrollment, and scheduling of classes.
Technology Acceptable Use Agreement
(Required)
By checking this box, your child is accepting the terms of the ESVCA Technology Acceptable Use Agreement
You are acknowledging that your child will appropriately use all school technology in accordance with all policies. The Technology Acceptable Use Agreement can be found on the website under the “Documents” tab located under “Our School.”
Media
(Required)
Yes – I give permission for my child to participate in any public or school media publication at Eschool Virtual Charter Academy.
No – I DO NOT CONSENT to the school and/or district’s use of my child’s photograph, voice and/or name in various media projects.
Field Trip
(Required)
Yes – I give permission for my child to attend school related field trips.
No – I DO NOT CONSENT for my child to participate in school and/or district approved field trips.
Text Messages
(Required)
Yes – I give the school permission to send me text messages regarding school information and/or updates.
No – I do not give the school permission to send me text messages regarding school information and/or updates.
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Name
*
First
Last
Email
*
Phone
*
Your Message
*
Email
This field is for validation purposes and should be left unchanged.
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