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{"sheet":"USD2 Virtual Academy App","index":0,"n_rows":77,"n_cols":21,"rows_kept":77,"cut":false,"hidden":false,"merged":[[21,14,21,16],[25,14,25,16],[24,14,24,16],[23,5,23,7],[46,3,46,8],[17,4,17,5],[8,1,8,10],[15,2,15,5],[11,4,11,5]]}
[]
[]
[]
[null,null,""]
[null,"Page 1",null,null,null,null,null,null,null,null,null,null,"Page 2"]
[null,null,null,null,null,null,null,null,null,null,null,null,"Student referred from:"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"",null,null,null,""]
[]
[null,"Unified School District #2 Virtual Academy Application",null,null,null,null,null,null,null,null,null,null,"DCF Worker:",null,"",null,null,null,null,""]
[]
[]
[null,"Student First Name:         ","",null,"Last Name:","",null,null,null,null,null,null,"DCF Worker Office:"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"Student Address:","",null,null,"City:",null,null,null,null,null,null,"Surrogate Parent:",null,""]
[]
[null,"Zip:","Email Address:","",null,null,null,null,""]
[]
[null,"Student Cell No.:  ",null,null,"Student Home No.:  ",null,null,null,null,null,null,null,"To certify your application, provide electronic signatures (sign your full names) below:"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"ENTER ELECTRONIC SIGNATURE: ",null,null,null,null,null,null,null,""]
[null,"DCF Link Case Number: ",null,null,null,"Date of Birth: ",null,null,null,null,null,null,"(Student)"]
[null,null,""]
[]
[null,"Dominant Language:",null,"",null,"English Language Learner?",null,null,null,null,null,null,"ENTER ELECTRONIC SIGNATURE: ",null,null,""]
[null,null,null,null,null,null,null,null,null,null,null,null,"(Adult Submitting Application)"]
[null,"Please check any that apply:"]
[]
[]
[null,null,null,null,null,null,false]
[null,null,null,null,null,null,false]
[]
[null,"If SPED, Disability Designation: ",null,null,null,null,null,null,null,null,null,null,null,"Before submitting, please read and check the box below:"]
[]
[]
[null,"Current Enrolled School: ",null,null,null,null,null,"Grade:"]
[null,null,null,null,null,null,null,null,null,null,null,null,"PLEASE READ INSTRUCTIONS BELOW BEFORE SUBMITTING:"]
[null,"Last School Attended:",null,null,null,null,"Expected Year of Graduation: ",null,null,null,null,null,"Click \"Submit Application\" to email a copy of the completed application."]
[null,null,null,null,null,null,null,null,null,null,null,null,"Click \"Allow\" in Outlook if/when prompted. The email will be in your sent folder."]
[null,null,"",null,null,null,null,null,null,null,null,null,"Do not send more than one email. Call 860-550-6436 with questions/concerns."]
[null,"Student LEA:",null,null,null,null,null,null,null,null,null,null,"Please send any additional documents (student transcript, IEP, etc.) to:"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"Guidance Counselor:"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"",null,null,null,null,null,""]
[]
[null,"Are you interested in (check all that apply)?",null,null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,null,null,null,null,""]
[]
[null,null,null,null,"Access to a computer and internet:",null,null,null,null,null,null,null,null,null,null,null,""]
[null,null,null,null,"(USD#2 does not provide internet access)"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[null,"Intellectual Disability"]
[null,"Hearing Impairment"]
[null,"Speech or Language Impairment"]
[null,"Visual Impairment"]
[null,"Emotional Disturbance"]
[null,"Orthopedic Impairment"]
[null,"Other Health Impairment"]
[null,"Other Health Impairment - ADD/ADHD"]
[null,"Specific Learning Disability"]
[null,"Deafness/Blindness"]
[null,"Multiple Disabilities"]
[null,"Autism"]
[null,"Traumatic Brain Injury"]