Galena USD 499

Adult Galena Virtual School Application

Please fill out this application if you are an adult (20 years old or older) interested in attending Galena Virtual School for the 2024-2025 school year. All required fields are preceded with an *.

Student Demographic Information
*First Name	*Middle Initial(s)	*Last Name	Maiden Name


*Date of Birth (mm/dd/yyyy)	*Gender	*Hispanic or Latino	*Ethnicity (select all that apply)
			White Black Asian Hawaiian/Pacific Islander Alaskan or Native American

*Address	*City	*State	*Zip Code


*Phone Number	*Email Address	Preferred Method of Communication (select all that apply)
		Call Email Zoom
High School History Please provide the information of the school with the most recent records.
*School Name	*City	*State	*Phone Number


*Last Grade Level Completed	*Year of Completion


*I give Galena Virtual School permission to request, transfer, or discuss my school records with other high schools or learning facilities.
I agree
Agreements Please read each section below and answer the following questions.
Student Handbook
Please refer to the Galena Virtual School Handbook for the most current information and answer the below question.
*I have read and agree to the terms in the handbook.



Acceptable Use Policy
Please read the Acceptable Use Policy and answer the below question.
*I have read and agree to the terms of the policy.



Data Sharing Consent for 3rd Party Apps/Vendors
In order for Galena Unified Schools #499 to continue to be able to provide students with the most effective web-based tools and applications for learning, we need to abide by federal regulations that require a parental signature/consent as outlined below: Galena Unified Schools #499 utilizes several software applications and web-based services that are operated by third party apps/vendors. The list of apps/vendors includes, but is not limited to the following: Google Apps for Education, Google Drive LTI by Canvas, Seesaw, Apple iOS, HMH Student Google Suite, Autodesk Inc, Canvas, PowerSchool Mobile, Career Cruising SSO, Xello, Adobe, and PowerSchool App. In order for our students to use these programs and services, certain personal identifying information, generally the student’s name and email address (considered “directory information”) must be provided to the web site operator. Under federal law, these websites must provide parental notification and obtain parental consent before collecting personal information from children under the age of 13. The law permits schools such as Galena Unified Schools #499 to consent to the collection of personal information (directory information) for educational purposes on behalf of all of its students, thereby eliminating the need for individual parental consent given directly to the web site operator. This form will constitute consent for Galena Unified Schools #499 to provide personal identifying information for your child consisting of first name, last name, email address and username to the following web-operators: Google Apps for Education, Managed Apple IDs, Google Drive LTI by Canvas, Seesaw, Apple iOS, HMH Student Google Suite, Autodesk Inc, Canvas, PowerSchool Mobile, Career Cruising SSO, Xello, Adobe, PowerSchool SSO and to the operators of any additional web-based educational programs and services which Galena Unified Schools #499 may add during the upcoming academic year.
*Consent



iPad Policy
Please read the Galena Unified School District 499 iPad Policy and answer the below question.
*I have read and understand the rules, guidelines, and expectations as outlined in this document. I agree to these terms and conditions.



*I plan to pay the $25 enrollment fee by:


By submitting this form, I am providing my digital signature agreeing that the information given on this form is true, complete, and accurate.
*Full Name	*Initials	*Date (mm/dd/yyyy)

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Adult Galena Virtual School Application