JEFFERSON COUNTY ESC VIRTUAL LEARNING ACADEMY
740-283-3347

SUMMER ENRICHMENT PROGRAM ENROLLMENT APPLICATION
2019

Student Name: ____________________________________________________

Name of Parent(s)/Guardian: ________________________________________

Address: _________________________________________________________ Street	City	State	Zip

Phone #: _____________________	Email Address: ___________________

School District: ___________________________________________________

Indicate the requested grade level of work to be completed throughout the Summer Enrichment Program.
K
	1st
	2nd
	3rd
	4th
	5th
	6th
	7th
	8th

Parent/Guardian Signature: ____________________________________Date: _______

Summer Enrichment Program Details:
     Student Enrollment Fee……………………………………….$50 per student      Sibling Discount (-$25)……………………………….………..$25 per student
	Student will obtain:
o Individual username/password to gain access to the Online Summer Enrichment Program (This will be emailed to the email address provided above.)
o Each student will be assigned a Highly Qualified Teacher to monitor activity and answer any questions
o Lessons are self-paced
o Students will have access to the Enrichment Program courses from June 1, 2019 – September 1, 2019.
o Upon completion of the Summer Enrichment Program, students will receive a “Certificate of Completion”.
o Enrollment Application and Payment MUST be received before a student is enrolled into the program. No refunds available.
 Mail enrollment application & payment to: (Check &/or Money Order)
Jefferson County ESC Virtual Learning Academy 2023 Sunset Boulevard
Steubenville, Ohio 43952