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9-12 Greenbush Virtual Academy Intake  
Greenbush Virtual Academy offers a personalized learning experience for grades 9-12, through a customizable blend of online classes.  Our virtual learning programs operate in partnership with local school districts to provide students a chance to earn their high school diploma.  Please provide us with some information about the student and complete the questionnaire to gauge potential success as an online learner.
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Counselor's Name and district number: *
Parent's Name
Parent's email
Parent's contact number
Student Name *
Student's contact number *
Grade in School:  Check one *
Please answer the following questions honestly.
How well would online learning classes fit your circumstances and lifestyle?  Select the option for each question that best describes your circumstances.  Students who tend to be most successful are those individuals who are comfortable with technology, self-directed and self-motivated in their learning and study habits.  The purpose is for you to reflect on whether or not online learning is a good learning method for you and to schedule an appointment with an Academic Coach from Greenbush Virtual Academy.
Why does student want to attend online school?  
Has student participated in virtual education in the past? *
If student has participated in virtual education, were they successful?  Where did the student attend? *
My technology access is best described as: *
I will be able to meet with my teachers and academic coach via Zoom when deemed appropriate? ( must have web cam and microphone) *
When I need help understanding a subject: *
I would classify myself as someone who: *
When I am given instructions to finish an assignment, I prefer: *
I need my instructor to provide feedback on my assignments: *
I need my instructor to answer my messages and/or questions: *
Considering my work and personal schedule, the amount of time I have to work on my course work is: *
I would classify my skills in math as: *
My reading and writing abilities are: *
As a student, what are your expectations for your education while at GVA?
As a parent, what are your expectations for your student's education while at GVA?
What is the name of the adult(s), that will be checking/tutoring with this student on a daily basis? (Parents, Grandparents, Family Friend)
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