STUDENT INFORMATIONStudent Name(Required) First Middle Last Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Birthdate(Required) MM slash DD slash YYYY Age(Required)Grade(Required)Education Level(Required) Elementary Middle High Special Education?(Required) Yes No REQUEST INFOMATIONI am requesting:(Required) To take a virtual class To take an in person class at a school To participate in extracurricular activities (Eg. Robotics, Sports, Band, Etc.) What Virtual Course(s) are you requesting?(Required)Date you would like to begin Virtual Course(s)(Required) MM slash DD slash YYYY What In Person Course(s) are you requesting?(Required)Which Elementary School are you wanting to take In Person Courses at?(Required)Alban ElementaryAlum Creek ElementaryAndrews Heights ElementaryAnne Bailey ElementaryBelle ElementaryBridgeview ElementaryCedar Grove Elementary Central ElementaryChamberlain ElementaryChesapeake ElementaryClendenin ElementaryCross Lanes ElementaryDunbar Intermediate CenterDunbar Primary CenterEdgewood ElementaryElk Elementary CenterFlinn ElementaryGeorge C. Weimer AnnexGrandview AnnexHolz ElementaryKanawha City ElementaryKenna ElementaryLakewood ElementaryMalden ElementaryMary C. Snow West Side ElementaryMary Ingles ElementaryMidland Trail ElementaryMontrose ElementaryNitro ElementaryOverbrook ElementaryPiedmont Year-Round EducationPinch ElementaryPoint Harmony ElementaryPratt ElementaryRichmond ElementaryRuffner ElementaryRuthlawn ElementarySharon Dawes ElementaryShoals ElementarySissonville ElementaryWeberwood ElementaryWhich Middle School are you wanting to take in Person Coures at?(Required)Andrew Jackson MiddleDu Pont MiddleDunbar MiddleEast Bank MiddleElkview MiddleHayes MiddleHorace Mann MiddleJohn Adams MiddleMckinley MiddleSissonville MiddleSouth Charleston MiddleWest Side MiddleWhich High School are you wanting to take in Person Courses at?(Required)Capital HighGeorge Washington HighHerbert Hoover HighNitro HighRiverside HighSaint Albans HighSissonville HighSouth Charleston HighDate you would like to begin In Person Course(s)(Required) MM slash DD slash YYYY Which Extracurricular Activities are you wanting to participate in?(Required)Which Elementary School are you wanting to participate in activities at?(Required)Alban ElementaryAlum Creek ElementaryAndrews Heights ElementaryAnne Bailey ElementaryBelle ElementaryBridgeview ElementaryCedar Grove Elementary Central ElementaryChamberlain ElementaryChesapeake ElementaryClendenin ElementaryCross Lanes ElementaryDunbar Intermediate CenterDunbar Primary CenterEdgewood ElementaryElk Elementary CenterFlinn ElementaryGeorge C. Weimer AnnexGrandview AnnexHolz ElementaryKanawha City ElementaryKenna ElementaryLakewood ElementaryMalden ElementaryMary C. Snow West Side ElementaryMary Ingles ElementaryMidland Trail ElementaryMontrose ElementaryNitro ElementaryOverbrook ElementaryPiedmont Year-Round EducationPinch ElementaryPoint Harmony ElementaryPratt ElementaryRichmond ElementaryRuffner ElementaryRuthlawn ElementarySharon Dawes ElementaryShoals ElementarySissonville ElementaryWeberwood ElementaryWhich Middle School are you wanting to participate in activities at?(Required)Andrew Jackson MiddleDu Pont MiddleDunbar MiddleEast Bank MiddleElkview MiddleHayes MiddleHorace Mann MiddleJohn Adams MiddleMckinley MiddleSissonville MiddleSouth Charleston MiddleWest Side MiddleWhich High School are you wanting to participate in activities at?(Required)Capital HighGeorge Washington HighHerbert Hoover HighNitro HighRiverside HighSaint Albans HighSissonville HighSouth Charleston HighDate you would like to begin Extracurricular Activities(Required) MM slash DD slash YYYY Are you a Hope Scholarship Recipient? Yes No Remaining Balance of Hope ScholarshipEach request is 1/7 of the amount of the total Hope Scholarship View the amount of the Hope Scholarship HERE Total amount due prior to starting a course and/or an extracurricular activityPARENT INFORMATIONParent Name(Required) First Last Phone(Required)Email(Required) Parent Signature(Required)Date(Required) MM slash DD slash YYYY Assign Principal to be Notified(Required)JOHNNA JACOBSELIZABETH HOYLMANY SUZANNE CONLEYROBERT SOMERVILLELINDA BURKEDEBORAH MOUGAESWHITNEY CANADAPHOEBE MCCLOUDKIMBERLY POSEYANGEL GURSKIJodi HypesMICHELLE ADAMSMARIA CLENDENINJENNIFER MATHISLynn DavisCATHI BRADLEYNATALIE VAUGHANDUSTY HERSCHERJULIE SAYRECYNTHIA SCHILLINGGRANT DAVISPAMELA SNEADASHLEY GARRETTKathryn HerscherKAREN MESSINGERASHLEY HOPE DUGGANJACQUELINE HERSCHJENNIFER CUMMINGS-COCHRANHENRY NEARMANNATALIE LALIBERTYHILARY SUMMERHILLDAVID ANDERSONDAVID AGNEWMARY MUNOZKAMI LUCASStephenie HaynesDANA GROGGAMY BROWNDESTINY SPENCERCHRISTINA BRIDGETTEJOHN MOYERSRHONDA DONOHOEABBY STEVENSROMIE CANTERBURYMICHAEL WILKINSONMELISSA LOVEJOYKARA DUNBARELIZABETH RYANAMY SCOTTCLIFFORD NICHOLASKIZMET CHANDLERCANDICE STEELEJIM CRAWFORDMICHAEL KELLEYBRIAN BARTHJACLYN SWAYNEROBERT SMITHRyan CarterLARRY BAILEYSTEPHEN LOFTISNICOLE MCCARTNEYJENNIFER STOWERSLISA DORSEYThis field is hidden when viewing the formPrincipal Email
