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All Students 18 and older will need to complete the following forms in order to enroll in the 21st Century Learning Academy.  Click on the title to download a PDF version of the form.  

Adult Learner Pre-Enrollment Questionnaire

Please take a few minutes to answer each of the following questions so that we can gain a better understanding of your abilities and needs.

Adult Learner Application and Agreement Form

The Application and Agreement Form consists of five (5) separate sections that will all need to be read, filled out and signed by both the student applying for admittance and their parent or guardian.  Please read the application carefully to ensure that you do not miss any of the questions or signature locations.  This form can be filled out on the computer, but it will need to be printed out once it is complete and mailed back to the 21st Century Learning Academy office.

Adult Learner Enrollment Form

Please fill out the enrollment form to gain admittance to the 21st Century Learning Academy. This form consists of Student Information, Parent Information, Emergency Contact Information, Previous Education and Race/Ethnicity Information that is required by the State of Kansas.  This form can be filled out on the computer, but it will need to be printed out once it is complete and mailed back to the 21st Century Learning Academy office.

Transcript Request

The Transcript Request Form needs to be filled out by each potential student so that the 21st Century Learning Academy can request records from the last school attended.  This is necessary so that we can determine what classes a potential student needs to take through the 21st Century Learning Academy in order to graduate.  This form can be filled out on the computer, but it will need to be printed out once it is complete and mailed back to the 21st Century Learning Academy office.

2016-2017 At Risk Application

The At-Risk Application is a required form by the State of Kansas that all School Districts must provide.  This form is necessary to verify income levels for various fundings and assessment issues with the state.  If you are certain that you do NOT qualify, please make that note, sign and return the form.  Otherwise, complete the entire form and sign and date it.  If you have a case number, we need a copy of the case form.  This form will have to be printed out and then completed by hand in either blue or black ink.  Please return the completed form to the 21st Century Learning Academy office.

Home Language Survey

Upon enrollment, every student or parent/guardian must be given a Home Language Survey. This survey will be used to determine which students should be assessed for English proficiency. Knowledge of, or exposure to another language does not, in and of itself, qualify a student for ESOL services. If a language other than English is indicated in any of questions 1-4, the student will be assessed to determine eligibility for English for Speakers of Other Languages (ESOL) services. Please complete one for for each student.

 



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