Fill Out Your Agora Enrollment Packet Form
For families considering enrollment in Agora Cyber Charter School, the Agora Enrollment Packet form is a critical tool. This packet includes various sections that ask for essential information about the student and their background. Required documents vary by grade level and personal circumstances, covering proof of age, residency, and immunization records. Parents must submit specific forms, including the Charter School Student Enrollment Notification Form and information about any special education services the child may have received. The submission process allows families to fax, email, or mail the necessary documentation. Copies of documents are preferred. Additionally, there are sections dedicated to reporting any prior disciplinary actions involving the student as well as gathering information related to their home language, ensuring they receive appropriate support during their education. Overall, this packet simplifies the administrative aspects of enrolling in a charter school, ensuring that families have a clear guide to follow throughout the process.
Agora Enrollment Packet Example
Agora Cyber Charter School
Enrollment Processing Center
2300 Corporate Park Drive
Suite 200
Herndon, VA 20171
Ph. 1.866.548.9451
Fx. 1.866.529.0166
www..k12.com/agora
Enrollment Forms Packet (EFP)
Please review the information below. Based on your student(s) grade and applicable circumstances, you are required to sub- mit documentation in order to complete this step in the enrollment process. You can fax, scan and email, or mail the required paperwork .
Important Note: Please send copies, do not mail the original documents |
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Fax (preferred): |
Scan and Email: |
Mail: |
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agorafax@k12.com |
Agora Cyber Charter School |
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2300 Corporate Park Drive |
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Suite 200 |
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Herndon, VA 20171 |
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Proof of Age |
Oficial Birth Certiicate (not the hospital issued certiicate) |
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Please submit one of the following: |
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Proof of Residency |
Current Utility Bill (gas, water, electric, sewage, cable or land line phone) with service address OR |
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Valid Pennsylvania Driver’s License OR Department of Transportation ID OR Mortgage statement/ |
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Current Lease with signature OR Valid Vehicle Registration OR Property tax bill OR Deed |
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Immunization Record |
Current Immunization Record OR Immunization Exemption Form |
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Charter School Student |
By illing out this form, you have indicated your decision for your child to attend Agora and that |
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Enrollment Notiica- |
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your child will not be enrolled in another school while attending Agora. |
this packet |
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tion Form |
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Required for all |
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Please note that you should only write an “X” in one of the blanks to indicate if your student WAS/ |
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Students |
Notiication of Offense |
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IS or WAS/IS not expelled or suspended. Only ill out the boxed section if it applies to your student. |
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Form |
this packet |
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The form must be signed and submitted for all students. |
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Home Language |
Please read the directions for this form to ensure you answer the questions correctly |
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Survey |
this packet |
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Provided |
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ment Information Ses- |
This form serves as conirmation the parent or guardian attended the Face to Face Enrollment Ses- |
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sion Acknowledgement |
sion. |
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Orientation |
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of Attendance |
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Session |
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By illing out this form, you are giving our school permission to request your student’s oficial re- |
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Release of Records |
cords from their previous school after the approval process. If your child is enrolling in Kindergar- |
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this packet |
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ten or was Homeschooled please indicate it on the form, ill out the top portion and sign it. |
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Required for all 1st |
Report Card |
Please submit your student’s most recent report card. |
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Required for all 10 |
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You will need to request an unoficial transcript from your student’s current school, which will |
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Unoficial Transcripts |
show your student’s academic standing. This is required in order to place all 10th - 12th graders. |
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Once your student is approved, we will receive the oficial transcript directly from the school. |
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Required for Prior |
Afidavit, Educational |
This is the form that you would have iled with the district registering your child as a home |
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Home School Stu- |
Objectives and Evalu- |
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schooled student. |
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Required for student |
IEP |
A copy of your student’s current IEP (Individualized Education Plan). Because the IEP expires |
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yearly, please submit the current IEP. |
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with an IEP or other |
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Special Education |
Evaluation Report |
The Evaluation Report is valid for 3 years. If you do not have a copy of your student’s ER, you |
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can request a copy from your student’s current school. |
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Required for students |
504 Accommodation |
A copy of your student’s current 504 Accommodation Plan. Because the 504 expires yearly, please |
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that have a 504 plan |
Plan |
submit the current 504. |
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Charter School Student Enrollment Notification Form
For School Year
-1
Warning: A child enrolled in another public school or a nonpublic or private school cannot, at the same time, enroll in a charter school, but is permitted to complete an application for enrollment while enrolled in other school.
Name of Charter
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Agora Charter Cyber School |
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Address: |
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995 Old Eagle School Road Suite 315 |
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Wayne, PA 19087 |
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Charter School |
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Business Office |
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Telephone: |
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enrollment@agora.org |
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I. Student Information:
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Name: |
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Home |
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Different From |
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Home Address) |
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II. School District of Residence and Former School Information
School District of
Residence:
Former School Information (Other Than |
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School |
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Charter School |
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Home School |
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Student Not Enrolled in School Preceding Enrollment in Charter School Because: |
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Entering |
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Kindergarten |
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Address of Former School: |
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Withdrawal Date From Former |
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Was Your Child Receiving Special Education Services Based On An Iep? |
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If Yes, Do You Have The Child’s Special Education Records (Iep)? |
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Page 1 of Charter School Student Enrollment Notification FormPDE 7/2002 Instructions for this can be found at www.pde.state.pa.us. Under the
III. Parent/Guardian Information:
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Both Parents |
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Mother |
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Child Lives With: |
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Special Custodial Court Instructions: |
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(If Yes, Please Provide a Copy of Court |
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Order.) |
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Yes |
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Complete Parent/Guardian Name and Address Information As Applicable
Father’s Name
Address:
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Home Telephone: |
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Work Telephone: |
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Mother’s Name |
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Address: |
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Home Telephone: |
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If The Student Is Not Living With Parents, Please Complete This Section.
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Guardian’s Name |
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Foster Parent’s Name |
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Other Adult Name |
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Name: |
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Address: |
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My signature on this form indicates my decision to have my child attend the charter school named on page 1 of this form and signifies my request that appropriate school records be forwarded from the school district to the charter school. My signature also certifies that my child is not, and will not be, enrolled in another public school, a nonpublic school or a private school at the same time he or she is enrolled in this charter school.
Signature of
Parent/Guardian:Date:
IV. To Be Completed By Charter School:
Verification of Date of Birth: |
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Birth Certificate |
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Other |
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Proof of |
Mortgage |
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Residency |
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Statement |
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Lease |
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Official Enrollment Date: |
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Anticipated Date of Attendance: |
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Grade Student Is Entering:
Signature of Charter School
Representative:
Page 2 of Charter School Student Enrollment Notification Form |
PDE 7/2002 |
2300 Corporate Park Drive
Suite 200
Herndon, VA 20171
Toll Free: 877‐36 AGORA (362‐4672)
Office: 610‐254‐8218
Fax: 866‐529‐0166
www.agora.org
NOTIFICATION OF OFFENSE INVOLVING WEAPONS, ALCOHOL OR DRUGS, INFLICTION OF INJURY TO ANOTHER PERSON, OR ANY ACT OF VIOLENCE, COMMITED ON SCHOOL PROPERTY
Parental Registration Statement
Student Name
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Parent or Guardian Name |
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Home Address |
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Home Phone |
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Alternate Phone_____ |
__________________ |
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Agora Virtual Charter School is committed to comply with the Safe Schools Act to ensure the safety and
Please check the appropriate box below and sign: (if you indicate “Yes” please complete the remainder of this form and sign)
I hereby swear or affirm that

YES, My child has been previously suspended or expelled OR currently is suspended or expelled from any public or private school of this Commonwealth or any other state for an act or offense involving weapons, alcohol or drugs, or for the willful infliction of injury to another person or for any act of violence committed on school property.

NO, My child has not been previously suspended or expelled OR currently is suspended or expelled from any public or private school of this Commonwealth or any other state for an act or offense involving weapons, alcohol or drugs, or for the willful infliction of injury to another person or for any act of violence committed on school property.
I make this statement subject to the penalties of 24 P.S.
**Please complete if your child has been or is presently suspended or expelled from another school** My child was suspended expelled from the following school:
Name of the school: __________________________________________ Telephone:________________________________
School Address:____________________________________________________________________________________________
Suspension/ Expulsion Start Date: _____________________________________ (MM/DD/YYYY)
Suspension/ Expulsion End Date: ______________________________________ (MM/DD/YYYY)
(Please provide additional schools and dates of expulsion or suspension on back of this sheet.)
Reason for suspension/expulsion. (Please check all that apply) o Offense involving weapons
o Offense involving alcohol o Offense involving drugs
o Willful infliction of injury to another person
o An act of violence committed on school property o Other Additional comments:
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(Parent or Guardian Signature) |
(Date) |
Thank you for completing the following information on the Home Language Survey. This is information the Pennsylvania Department of Education requires be collected by all educational entities during initial enrollment.
The first three questions relate to your child’s first language. Please do not include languages learned in school. As part of the enrollment process, this information will assist us in identifying any supports that your child may need.
Question four asks if your child has attended school in the United States for any three years. These years do not have to be consecutive. Please complete the name of school, state and dates attended for the most current schools your child has attended in the United States. These include preschool, private schools and home schooling.
If someone other than the parent completed the form please note where it indicates. Please leave blank otherwise.
The form is completed by the parent/guardian signing where indicated.
We thank you in advance for taking the time to complete this form.
________________________________________________________________________
HOME LANGUAGE SURVEY*
The Office of Civil Rights (OCR) requires that school districts/charter schools/full day AVTS identify limited English proficient (LEP) students in order to provide appropriate language instructional programs for them. Pennsylvania has selected the Home Language Survey as the method for the identification.
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Student’s Name: |
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1.What is/was the student’s first language? __________________________
2.Does the student speak a language(s) other than English? (Do not include languages learned in school.)
Yes No
If yes, specify the language(s): ____________________________________
3.What language(s) is/are spoken in your home? ______________________
4.Has the student attended any United States school in any 3 years during his/her lifetime?
Yes No
Name of School |
State |
Dates Attended |
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Person completing this form (if other than parent/guardian): Parent/Guardian signature: ______________________ Date: _____________
*The school district/charter school/full day AVTS has the responsibility under the federal law to serve students who are limited English proficient and need English instructional services. Given this responsibility, the school district/charter school/full day AVTS has the right to ask for the information it needs to identify English Language Learners (ELLs). As part of the responsibility to locate and identify ELLs, the school district/charter school/full day AVTS may conduct screenings or ask for related information about students who are already enrolled in the school as well as from students who enroll in the school district/charter school/full day AVTS in the future.
Agora Cyber Charter School
Enrollment Processing Center
2300 Corporate Park Drive
Suite 200
Herndon, VA 20171
Ph. 1.866.548.9451
Fx. 1.866.529.0166
www..k12.com/agora
Release of Student Records
Please accept this document as formal approval for the release of all official school records (including the record of transcripts, testing information, special education, health and immunization records).
Student Information
Student’s Full Name:
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Student’s Date of Birth: |
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Student’s Legal Address: |
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Home Phone: |
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Homeschooled or Never Previously Enrolled in School (Fill out only if applicable)
Check below if applicable:
oStudent was always previously homeschooled
oStudent is enrolling in Kindergarten
Prior School Information
NameofPriorSchool:
School’s Address:
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School’s Phone: |
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Sign and Date below
Name of Parent or Legal Guardian:
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Parent/Guardian’s Signature: |
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Date: |
SCHOOL OFFICIALS ONLY:
SCHOOL OFFICIALS ONLY:
SCHOOL OFFICIALS ONLY:
Send student records to: Agora Cyber Charter School |
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Send student records to: |
Virginia Virtual Academy |
Send student records to: |
995 Old Eagle School Road |
Washington Virtual Academies |
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2300 Corporate Park Drive, Suite 200 |
Suite 315
1584 McNeil Street, Suite 200
Herndon, VA 20171
Wayne, PA 19087
DuPont, WA 98327
Student’s Name: |
Student’s Home Phone: |
19
2300 Corporate Park Drive
Suite 200
Herndon, VA 20171
Toll Free:
Office:
Fax:
www.agora.org
Acknowwledgment of Legal Guardianship
Student Name: ____________________________________________
Date of Birth___________________________
I understand that false statemennts herein are made subject to the penalties of the crimes code, chapter 49, subchapter A, sections 4901 to 4904, relating to perjury and falsification in official matters.
Please complete ONE of the following:
1.I (We) am the NATURALL parent(s) of the named student. I (We) retain custodial rights to enroll the student in the Agora Cyber Charter School.
Mother Name ___________________________________________________________________
Signature ________________ __________________________ Date______________________
Father Name ___________________________________________________________________
Signature ________________ __________________________ Date______________________
2.I am the court appointed guardian, adoptive parent or foster parent of the named student. I will provide the appropriate documentation to enroll the student in the Agora Cyber Charter School.
•Court Ordered Custoody Agreement
•Adoption Decree
•Verification of Fosteer Care Placement (such as a letter from the appropriaate agency)
•Other Appropriate Legal Documentation
Name________________________________________________
Signature ___________________________________________ Date_____________________
Relationship to student_____________________________________
3.I am the primary care givver of the name student. I will provide the appropriiate documentation to enroll the student in the Agora Cyber Charter School.
•If you are not the leggal guardian of the named student but are supporting the student gratis, (without personal coompensation or gain), will assume all personal obligatiions for the student relative to school re quirements and intend to keep and support the student continuously and not merely through the school term, you are required to submit the Agora Cyber Charter School Sworn and Notarized Statement. Please request this form by contacting
Care GiverName_______ ___________________________________________ _______________
Signature ___________________________________________ Date_______________________
Relationship to student_____________________________________
Form Characteristics
| Fact Name | Fact Description |
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| Location | The Agora Enrollment Packet is processed at 2300 Corporate Park Drive, Suite 200, Herndon, VA 20171. |
| Preferred Submission Method | Fax is the preferred method for submitting the required paperwork at 1-866-529-0166. |
| Required Documents | Documents such as proof of age, residency, and immunization records must be provided to complete enrollment. |
| Current Immunization Requirement | Families must submit a current immunization record, unless opting for an immunization exemption form. |
| Existing Student Records | Parental permission is needed to request official records from the student’s previous school. |
| Notification of Prior Offenses | Parents must disclose any history of suspension or expulsion related to serious offenses as per Pennsylvania Act 26. |
| Home Language Survey | The Home Language Survey helps identify students requiring language support programs, as mandated by federal law. |
| Governing Laws | This enrollment process is governed by Pennsylvania law, specifically Act 26 of 1995 concerning student safety. |
Guidelines on Utilizing Agora Enrollment Packet
Completing the Agora Enrollment Packet form is a critical step in the enrollment process for students. Once you’ve gathered the necessary documentation, follow these steps to ensure your enrollment is processed smoothly. The form will require basic information about the student, their previous school experiences, and your family details. Accuracy is essential to avoid delays.
- Gather all required documentation, including proof of age, proof of residency, and immunization records.
- Fill out the student information section, noting the last name, first name, middle initial, and date of birth.
- Complete the school district of residence and former school information accurately. Indicate if the student has received special education services and if you have the necessary records.
- Provide details about the parent or guardian. Include names, addresses, and phone numbers. If the student is living with someone other than a parent, fill out that section as well.
- Sign and date the form, confirming that your child is not enrolled in another school at the same time.
- If applicable, answer the notification of offense questions honestly. Include details about any previous suspensions or expulsions.
- Complete the Home Language Survey, noting the student's first language and any other languages spoken.
- Review the entire form for accuracy and completeness before submitting it.
- Submit the completed form along with the required documentation by fax, email, or mail, ensuring you send copies, not originals.
What You Should Know About This Form
What is the Agora Enrollment Packet?
The Agora Enrollment Packet is a collection of documents required for enrolling your child in Agora Cyber Charter School. It includes forms that need to be filled out and submitted, along with supporting documentation that verifies your child’s age, residency, immunization records, and more. This packet ensures that the school gathers all necessary information for a smooth enrollment process.
How do I submit the completed Agora Enrollment Packet?
You may submit the completed enrollment packet in several ways: by faxing it to 1-866-529-0166, by scanning and emailing it to agorafax@k12.com, or by mailing it to Agora Cyber Charter School, located at 2300 Corporate Park Drive, Suite 200, Herndon, VA 20171. It is important to send copies of the required documents, not the originals.
What documents are required for enrollment?
Depending on your child's grade and specific circumstances, various documents are necessary. Key items include proof of age (an official birth certificate), proof of residency (such as a current utility bill), immunization records, the most recent report card for grades 1-9, and unofficial transcripts for grades 10-12. If applicable, you will also need to provide IEPs or 504 accommodation plans for students with special needs.
Can my child be enrolled in Agora while attending another school?
No, your child cannot be enrolled in Agora and another public, private, or nonpublic school simultaneously. However, if your child is currently enrolled in another school, you may still complete the Agora enrollment application while ensuring that the current school enrollment is terminated before starting at Agora.
What if my child has an IEP or 504 Plan?
If your child has an Individualized Education Plan (IEP) or a 504 Accommodation Plan, it is crucial that you provide the most current copies of these documents as part of the enrollment packet. The IEP must be from the current year, as these plans are updated annually. The 504 plan must also be up-to-date.
Are there any forms that apply to all students enrolling at Agora?
Yes, all students are required to fill out certain forms, including the Charter School Student Enrollment Notification Form and the Notification of Offense form. These forms help the school ensure compliance with state regulations and gather necessary information about the student’s enrollment history and any past disciplinary actions.
How can I ensure that my enrollment forms are processed smoothly?
To ensure a smooth processing of your enrollment forms, double-check that all required documents are completed accurately and signed. Always send copies of original documents, and consider submitting your forms via fax or email for faster processing. Following up with the enrollment office can also help address any outstanding issues.
Where can I find more information about the enrollment process?
Additional information regarding the enrollment process can be found on the Agora Cyber Charter School website at www.k12.com/agora. This site provides resources, contact information, and detailed instructions related to enrollment, ensuring you have access to everything you need.
Common mistakes
Filling out the Agora Enrollment Packet can be a daunting task, and errors can lead to delays in the enrollment process. One common mistake is failing to submit a valid proof of age. Parents sometimes send hospital-issued birth certificates instead of the official document. It's essential to provide an official birth certificate to ensure accuracy in enrollment.
Another frequent error is regarding proof of residency. Many individuals mistakenly submit outdated utility bills or incorrect documentation. Ensure that you provide a current utility bill with the service address or any other valid form of residency proof listed in the instructions.
Not filling out the Notification of Offense section accurately also causes issues. Parents should only check the applicable boxes about prior suspensions or expulsions. Oversights in this part of the form might result in misunderstandings during the admission process.
Some parents forget to sign the forms. This is critical, as failing to include a parent or guardian signature invalidates the entire packet. Double-check that all signatures are present before submission to avoid complications.
Inadequate attention to the Home Language Survey is another mistake. Parents need to answer all questions related to language accurately. This information helps the school determine necessary language support for the child.
Providing incomplete or missing immunization records is common as well. Parents often submit outdated records or assume that prior schools have forwarded necessary information. It is crucial to include the most recent immunization records or exemption forms to satisfy enrollment requirements.
Another significant oversight is neglecting to submit required documents for older students, such as unofficial transcripts for grades 10-12. Parents sometimes forget that this documentation is necessary for proper placement in courses. Ensure transcripts are requested and included with the enrollment packet.
Lastly, parents should make sure to send copies of all documents rather than the originals. Mailing original documents risks loss or damage, which could substantially hinder the enrollment process. Always create and submit copies to keep your records secure.
Documents used along the form
The Agora Enrollment Packet form is a crucial part of the enrollment process at Agora Cyber Charter School. This form ensures that all necessary information and documentation are collected to facilitate a smooth transition for students. Along with the enrollment packet, several other documents may be required. Below is a list of common forms and their purposes.
- Proof of Age: A certified birth certificate is needed to verify the student's age. This document confirms the child's eligibility for enrollment.
- Proof of Residency: A current utility bill or a valid driver's license helps establish the student's residence within the school's district. This documentation is essential for enrollment verification.
- Immunization Record: This record or an immunization exemption form is necessary to ensure that students meet health requirements before attending school.
- Notification of Offense: This form requires disclosure of any past suspensions or expulsions. It helps maintain a safe school environment by ensuring accountability.
- Home Language Survey: Participants complete this survey to help identify any language support needs for the student, assisting in the provision of appropriate services.
- Face-to-Face Enrollment Session Acknowledgement: This document confirms that the parent or guardian participated in an in-person enrollment session, an important step in the orientation process.
- Unofficial Transcript: For students entering grades 10 through 12, an unofficial transcript from their previous school aids in assessing their academic standing for proper course placement.
- IEP and Evaluation Reports: For students with special needs, providing the current Individualized Education Plan and Evaluation Report is vital to ensure that appropriate educational accommodations are in place.
Understanding these forms helps streamline the enrollment process for both families and the school. Each document serves a specific purpose and contributes to the overall goal of providing a supportive educational environment for all students.
Similar forms
- Student Enrollment Application: Similar to the Agora Enrollment Packet, the Student Enrollment Application collects essential information about the student and their family. Both forms require proof of residency, age, and often an acknowledgment of prior educational records.
- Proof of Residency Document: This serves to verify where the student lives, much like the residency proof needed for Agora. Both documents require evidence such as utility bills or lease agreements.
- Health and Immunization Records: Just like the Agora Enrollment Packet, many schools ask for current immunization records to ensure students meet health requirements for enrollment.
- Special Education Evaluation Form: If applicable, this document details a student’s special educational needs, mirroring the requirements in the Agora packet for students needing an Individualized Education Plan (IEP).
- Home Language Survey: Similar to the Agora form, most enrollments require this survey to identify students who may need additional language support, recognizing their home language.
- Notification of Offense Form: This document often is needed for many schools, providing information about any past suspensions or expulsions, much like the Agora's notification of offense requirement.
- Transfer Student Records Request: Similar to the release of records form in the Agora packet, this document permits one school to request records from another, ensuring smooth transitions.
- Parent/Guardian Consent Form: Most enrollment processes include this, much like the Agora Enrollment Packet, where consent is required for schools to obtain student records and provide necessary services.
Dos and Don'ts
Things You Should Do:
- Carefully read all instructions before filling out the form.
- Only submit copies of documents, not original copies.
- Provide a current proof of residency, such as a utility bill.
- Include a signed and dated Enrollment Notification Form for all students.
- Fill out the sections that apply to your child, especially in regard to any previous suspensions or expulsions.
Things You Shouldn't Do:
- Do not ignore required documentation, as it may delay the enrollment process.
- Do not write "X" in more than one option when indicating previous offenses.
- Avoid submitting an incomplete form; all sections must be filled as applicable.
- Do not use unofficial documents for proof of age and residency.
- Never submit forms late; adhere to all given deadlines to avoid complications.
Misconceptions
- Misconception 1: The Agora Enrollment Packet only requires documents from the parent or guardian.
- Misconception 2: All forms in the packet must be submitted as originals.
- Misconception 3: Any document proving residency is sufficient.
- Misconception 4: The Face-to-Face Enrollment Session is optional.
In reality, the Enrollment Packet asks for both documents provided by you and those that must come from the school, such as transcripts and report cards. You must gather materials from both sources to complete the enrollment process.
This is incorrect. You should only submit copies of the required documents, not the originals. Sending original documents may delay the enrollment process.
It is important to note that not all documents qualify. Only specific forms of proof, like current utility bills or mortgage statements, can be accepted. Double-check the list of acceptable documents to avoid any issues.
Actually, attending this session and signing the confirmation form is mandatory. It verifies that you received important information about the school and program.
Key takeaways
Filling out the Agora Enrollment Packet form is a crucial step in securing your child's place at Agora Cyber Charter School. Here are some key takeaways to help guide you through the process:
- Follow Directions Carefully: Take the time to read the instructions thoroughly. This ensures that you provide the correct documentation and avoid potential delays.
- Submit Copies Only: When providing documentation, remember to send copies rather than mailing original documents. This helps you retain your important papers.
- Check Your Proof of Residency: You can use several documents to prove residency, such as a current utility bill or a valid driver's license. Make sure the document matches the service address.
- Stay Organized: Gather all required documentation upfront, including your child's birth certificate, immunization records, and report cards. Keeping everything organized will simplify the submission process.
- Complete All Sections: Fill in every relevant part of the enrollment packet, including details like the home language survey and any special education plans for your child.
- Communicate with the School: If you have any questions or need assistance, don't hesitate to reach out to the Agora enrollment office. Their contact details are provided within the packet.
- Sign Everything: Ensure that all required signatures are in place. A missing signature could delay your child’s enrollment.
Taking these steps will help streamline your enrollment process and ensure that your child is ready to start their educational journey with Agora.
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