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GPFLEX Application
This form requires Javascript to be enabled for submission and authorization.
*
Required
How did you hear about us?
Student Name
*
required
First Name
Last Name
Age
*
required
Grade
*
required
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Student Phone Number
*
required
Sex
Male
Female
Prefer Not to Say
Parent/Guardian
*
required
First Name
Last Name
Relationship to Student
*
required
Parent/Guardian Phone Number
*
required
Parent/Guardian Email Address
*
required
Has the student been out of school?
*
required
Yes
No
If yes, please explain the circumstances:
What school are they currently attending or, what is the date/location of the last school attended?
*
required
Why is an alternative education placement being requested (check all that apply)?
Credit Deficiency
Attendance
Behavior
Social Emotional Concerns
Homeless
Teen Parent
Dropout Prevention
Other reasons for applying for GPFLEX or details of items checked above.
Does your student have medical needs?
*
required
Yes
No
If yes, please explain:
Please explain any additional details about your student's medical needs.
Does your student have academic challenges (ADD/ADHD, etc.)?
*
required
Yes
No
If yes, please explain:
Please explain any additional details about your student's academic challenges.
Does your student have an IEP?
*
required
Yes
No
Does your student have a 504?
*
required
Yes
No
Does your student have a job?
*
required
Yes
No
If yes, where and what hours?
Please include details about your student's job if applicable.
Has your student worked in an online environment before?
*
required
Yes
No
If yes, were they successful?
Has your student used Edgenuity before?
*
required
Yes
No
I don't know
Does your student desire a blended learning experience? (Some in-person classes and some online)
*
required
Yes
No
If yes, what classes would they like to take in person?
We agree that the above named student should be considered for GPFLEX.
Student Signature
*
required
Parent Signature
*
required
Date
*
required
Must contain a date in M/D/YYYY format
Submit