Enrollment – Pacific Virtual Learning

We're excited you've chosen Pacific Virtual Learning for your child's education! Please complete this form to begin the enrollment process. The form takes under five minutes to complete. All sections must be completed in order to submit your information. Partially completed forms cannot be saved. If you have more than one child, please complete a form for each child.

Enrollment type desired with Pacific Virtual Learning*

Full-time
Part-time

Student's Name*

First Middle Last

Student's Date of Birth*

Birth Country

Student's Gender*

Male
Female

Address*

Physical Street Address (No PO Box) Address Line 2 City State ZIP Code

Grade going into (K-8)

Does your student have an active IEP for Special Education Services?

Yes
No

Name of Last School Attended

Dates Attended Last School*

What language did your child first learn to speak?*

What is your child's primary language?*

What language does your child use the most at home?*

Guardian 1*

First Last

Guardian 1 Phone*

Guardian 1 Alternate Phone*

Guardian 1 Email*

Enter Email Confirm Email

Guardian 1 Relationship to Student*

Guardian 2

First Last

Guardian 2 Phone

Guardian 2 Alternate Phone

Guardian 2 Email

Enter Email Confirm Email

Guardian 2 Relationship to Child*

Military Parent of Guardian Affiliation-Washington State Legislature has mandated that data on students from military families must be collected as stated in RCW 28A.300.507. (please mark all that apply)

No parent or guardian currently serving as a member of the U.S. Armed Forces, Reserves of the U.S. Armed Forces or Washington National Guard.
Yes a parent/guardian is a current member of the active duty U.S. Armed Forces.
Yes a parent/guardian is a current member of the reserves of the U.S. Armed Forces.
Yes a parent/guardian is a current member of the Washington National Guard.
Yes more than one parent or guardian is currently either a member on active duty in the U.S. Armed Forces, Reserves of the U.S. Armed Forces or Washington National Guard.
No Response/Refused to state.

McKinney-Vento Program-Please mark all that apply

Please enter your full name and date below. By entering your name and date below, you are stating that you have the legal authority to make educational decisions on behalf of the student you are registering.*

Pacific Virtual Learning Application Form