Enrollment Form

Directions:

Fill out the application form below and click the submit button to apply online. We will review your application and contact you about official enrollment information and details.

Please Note:	We are currently taking applications for the 2008-2009 school year. This is not an official enrollment form, your student will be placed on a call list and you will be contacted by our office.
	Call 973.5181 or email Wichita eSchool for more information. You may also visit the Wichita eSchool office at 412 S. Main St., Room 214.

**Enrollment is closed after September 20 of each school year. Students must be enrolled prior to Sept. 20 to be eligible for Wichita eSchool courses.

Student's Last Name:

Student's First Name

Student's Age:

Student's Birthday (e.g.: 03/19/85)

Student's gender: Male Female

Special Education Program Yes No

(If yes what sp. ed. services?)

Student is currently expelled from school Yes No

Street Address:

City: Zip Code:

Phone: E-Mail:

Father/Guardian Name:

Father's Employer:Work#:

Mother/Guardian Name:

Mother's Employer:Work#:

Siblings currently enrolled in Wichita eSchool: No Yes

(If yes please list names here):

Grade Level for 2008-2009 School Year:

School District you live in:

Previous Enrollment:

Would like to use an eSchool computer? Yes No, using own computer

Reason for applying to the Wichita eSchool online program

Please send separate applications for each child.


You may apply by phone or Fax Phone 316.973.5181 FAX 316.973.7916 or mail the information to: Wichita eSchool Attn: Shawn Morris 412 S. Main Wichita, KS 67202	Please mail or fax an updated transcript for a high school student who is applying to: Wichita eSchool 412 S. Main Wichita KS 67202