Wapato Online Academy: 2023-24 School Year STUDENT INTEREST SURVEY

(Must be filled out as part of the enrollment process for WOA)

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* 1. Student Contact Information

Student Name

Address

City/Town

ZIP/Postal Code

Email Address

Phone Number

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* 2. Parent Contact Information

Parent Name

Address

City/Town

ZIP/Postal Code

Email Address

Phone Number

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* 3. What is your current school?

Simcoe

Camas

Adams

Satus

WMS

PACE

WHS

Other (please specify)

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* 4. Student Birthdate:

Please enter your birthdate MM/DD/YYYY

Date

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* 5. Student's Current Grade:

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* 6. Areas of Concern (parent or school)

Attendane

Discipline

Academic Performance

Other (please specify)

None of the above

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* 7. Current Special Accommodations:

Special Education

504

Health Impairment

Migrant

Homeless

Other (please specify)

None of the above

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* 8. Please tell us why you are interested in enrolling in the Wapato Public Schools Online Academy.

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* 9. How did you hear about the Wapato Public Schools Online Academy?

District website

Counselor

Friend

Other school personnel

Other (please specify)

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* 10. For which semester are you enrolling in the Wapato Public Schools Online Academy?

2023-24 Semester 1

2023-24 Semester 2

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* 11. Completing this survey does not guarantee placement in the online program.

I have read the above statement.