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GPFLEX Application

Required

Student Namerequired
First Name
Last Name
Sex
Parent/Guardianrequired
First Name
Last Name
Has the student been out of school?required
Why is an alternative education placement being requested (check all that apply)?
Does your student have medical needs?required
Please explain any additional details about your student's medical needs.
Does your student have academic challenges (ADD/ADHD, etc.)?required
Please explain any additional details about your student's academic challenges.
Does your student have an IEP?required
Does your student have a 504?required
Does your student have a job?required
Please include details about your student's job if applicable.
Has your student worked in an online environment before?required
Has your student used Edgenuity before?required
Does your student desire a blended learning experience? (Some in-person classes and some online)required

We agree that the above named student should be considered for GPFLEX.

Must contain a date in M/D/YYYY format