Taylion Student Re-enrollment Form

Taylion Student Re-Enrollment Application
Please fill out this application if you were enrolled in Taylion in the last 12 months. If you are a new student or have been withdrawn over 1 year ago, please fill out a new enrollment application.
Student Information
Full Name*

First NameMiddle NameLast Name
Student Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Current Age*
Birth Date*

MonthDayYear
Grade enrolling in*
Gender*

MaleFemale
State/Country of Birth*
Student Phone Number*
Who is your student mentor?
All Taylion students are assigned a student mentor.
Parent/Guardian Information
If you are a student 18 or older, you do not need to fill out the Parent/Guardian information.

A parent/guardian email is required for students under 18.
Mother/Guardian's Information
Full Name

First NameMiddle NameLast Name
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone
Cell Phone
E-mail
Place of Employment
Work Phone
Father/Guardian's Information
Full Name

First NameMiddle NameLast Name
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone
Cell Phone
E-mail
Place of Employment
Work Phone
Who is the student's legal guardian(s)?*
To whom should correspondence be addressed?*

Emergency Contact Information
Contact Name #1*
Relationship to Student*
Phone*
Alternate Phone
Contact Name #2
Relationship to Student
Phone
Alternate Phone
Who may pick up your student in your absence?*
Physician's Name
Physician's Phone

Acceptable Use Policy
PLEASE READ THE ACKNOWLEDGEMENT AND STUDENT ACCEPTABLE USE POLICY PAGES BEFORE SIGNING

Click to view the Acceptable Use Policy (page 2)

We (the student and parent/guardian) acknowledge that we have fully read and understand all policies set forth in this enrollment application. I (the student) allow Taylion Virtual Academy administration and teachers to discuss any pertinent information regarding my academic standing or enrollment with my parent/guardian.

By signing below, I (the parent/guardian) am also granting the student permission to access Taylion technology resources. We also understand that it is impossible for Taylion Virtual Academy to restrict access to all controversial materials, and will not hold them or related organizations responsible for such incidences.
Student Name*
Grade Level*
Student Signature

Clear
Date

MonthDayYear
Parent/Guardian Name or Student if 18+*
Parent/Guardian Signature or Student if 18+*

Clear
Date

MonthDayYear

Guidelines to Determine Eligible Students - State Required Form
The Arizona Department of Education provides the following FY 2020 Income Guidelines for determining eligibility information for federal funding associated with programs funded under the Elementary and Secondary Education Act, ESEA.

Please view the ESEA Eligibility Guidelines and answer the following questions:

Is your family at or below the current income guidelines based on the attached ESEA Eligibility Guidelines schedule?
Please select which indicator you qualify under:*

Indicator 1Indicator 2No
Definition of Income: All items such as wages and salaries before any deducations, and other income, such as self employment, welface, social security, retirement benefits unemployment compensation, workers compensation, Aid fo Depdendent Children, alimony, child support, pensions, insurance, or annuity payments, etc.

If your family qualifies, please complete the following information for each child:
Child's name
Name of School
Grade
Child's name
Name of School
Grade
Child's name
Name of School
Grade
Child's name
Name of School
Grade
I hereby certify that all of the above information is true and correct.

Arizona Department of Education Residency Documentation Form - State Required Form
The state requires an updated Proof of Residency for all re-enrolling students.

If the student is 18 years of age or older the Proof of Residency must be for the student themselves. If the student is under 18 the proof of residency must be for the Legal Guardian. Proof of Residency can be in the form of any of the following:
- An Arizona Driver's Licence or Arizona State issued ID
- Real Estate Deed or Mortgage Documents or Lease/Rental Agreement or
- Water, Electric, Gas, Cable or Phone Bill
- Bank or Credit Card Statement
- W-2 Wage Statement or Payroll Stub
If none of these forms are available, please contact us for a residency Affidavit that must be signed and notarized by an Arizona resident who attest that you have establish residence in Arizona with the person signing the affidavit.

The Proof of Residency must match the address listed on the re-enrollment form.

After you have completed the re-enrollment form Proof of Residency may be submitted by:

Fax - 602-889-7806
Email - nmaraskes@taylion.com
In person by appointment - 4744 W. Grovers Ave., Glendale, 85308
I have read and understand the Proof of Residency requirements.*

Yes, continue with re-enrollment form.No, please call our enrollment office at (602) 621-4391.

Acknowledgement
1. I verify that all information provided on the enrollment forms is correct and all questions were answered truthfully.

2. I have read the rights under the FERPA (Family Educational Rights Privacy Act) and PPRA (Protection of Pupil Rights Amendment).

3. I understand and agree that students may have a minimum weekly time requirement for course work and attendance. Failure to meet these requirements will affect the student’s enrollment status in the Taylion Virtual Academy programs.

4. I read and understand Taylion Virtual Academy’s policies and procedures as stated in the student handbook.

5. I understand and agree that all school work must be original and performed by the student that is enrolled. It is the responsibility of the parent/guardian and student to uphold Taylion’s virtue of integrity.

6. Standardized Testing acknowledgement for applicable students, as stated by Arizona law:

"Upon enrollment, the school shall notify the parents or guardians of the pupil of the state testing requirements. If a pupil fails to comply with the testing requirements and the school administers the tests pursuant to this subsection to less than ninety-five per cent of the pupils in Arizona online instruction, the pupil shall not be allowed to participate in Arizona online instruction."

Student will:

• Attend testing dates and take all required tests
• Arrange transportation to required testing

• Be withdrawn if they do not participate in required testing

• Meet all credit requirements and pass all required exams to receive a diploma

Please view and save a copy of the following documents for your personal records:

Acknowledgement

Immunization Requirements

Additional Enrollment Documents
Parent/Legal Guardian or Student (if 18+) Signature*

Clear
Date*

MonthDayYear
If you are finished completing the enrollment application, please click the submit button below.

Should be Empty:

Taylion Student Re-Enrollment Application

Student Information

Parent/Guardian Information

Emergency Contact Information

Acceptable Use Policy

Guidelines to Determine Eligible Students - State Required Form

Arizona Department of Education Residency Documentation Form - State Required Form

Arizona Department of Education Residency Documentation Form - State Required Form

McKinney - Vento Program Intake Form - State Required Form

Acknowledgement