Your Email

Student Name

Date of Birth

Parent / Guardian

Street

P.O. Box

City

 State  Zip

Email Address

Home Phone

Current School

Courses Requested

Assistance Needed:

Please indicate (special services, extra assistance in math, reading, etc.)

Considerations:

Please include any information which the IVLA staff should be apprised.

Documents:

Please list any forms or documents provided for review by IVLA.

I understand upon completion of this form I am pre-enrolling my student in International Virtual Learning Academy and will be required to pay the enrollment fee. After submitting this form a school administrator will contact me to verify course placement and provide login information. To request more information - CLICK HERE