2nd Semester-RCS Virtual School Opt-In Form

Application for Raleigh County Virtual Program

2nd Semester: January-June 2025
Raleigh County Virtual Consent Form- 2024-2025

I hereby consent to the West Virginia Virtual (Raleigh County) collection, use, and/or disclosure of information about my child through the course registration process and other manual and/or electronic procedures of the Virtual Program or associated course providers. I understand that my child is registering for a virtual course and that the information collected is needed for both course registration and grade/progress reporting to my child’s school. This consent form covers all forms of distance learning courses, included but not limited to satellite courses, video courses, and web-based courses. Your child’s image may be transmitted during video portions of distance learning and online courses.The information supplied to the course provider and/or the Virtual Program may include, but not be limited to student name, address, phone number, age, gender, school name, student grade in school, student email address, student progress and grade in the course/s.
A separate form must be completed for each child enrolling in the Raleigh County Virtual Program by Sunday, December 31st at 5:00 PM.

You must complete a separate Opt-In form for each student . The Opt-In form must be submitted on or before December 31, 2024, by 5:00 PM. This is an application only and DOES NOT guarantee acceptance into the program. Second semester classes will begin on January 21, 2025. Enrollment in the Raleigh County Virtual Program will be through the end of the second semester. Application for students who are receiving special services will be considered through the IEP process. All other student applications will be reviewed by the school eligibility team. Parents will be notified prior to January 8th regarding the acceptance of their application. Students must have completed the prior semester with a minimum 2.0 in all courses in order to be considered for virtual.
The RCS Virtual Platform will REQUIRE two live sessions per course per week and attend in-person Science labs. For students to remain eligible, parents AND students will be required to attend an orientation at Raleigh County Schools Central Office. Please email arwilliams@k12.wv.us for further information.
What is the intent for your child?*

Yes, I want my child to attend Virtual School, and I understand that my child will remain in VS until the end of the second semester.
Is your child currently homeschooled?*

YesNo
Does your child currently have an IEP?*

YesNo
Do you/Will you have reliable internet services in your home?*

YesNo
Yes, I want my child to attend Virtual School, and I understand that my child will remain in VS until the end of the second semester. (You can sign with your finger, mouse or a stylus)*

Clear
I have read and understand Raleigh County Policy E. 18 Virtual School (You can sign with your finger, mouse or a stylus)*

Clear
My student and I have reviewed and understand our responsibilities regarding Cyber Safety. (You can sign with your finger, mouse or a stylus)*

Clear
Date*

MonthDayYear
Date
School*
Grade:*
Child's Last Name*
Child's First Name*
Child's Middle Name
Parent/Guardian's Name*
Parent/Guardian's Email. (Please use a working email for receipt of completed forms)*
example@example.com
Mailing Address: (Street/PO Box)*
City*
State*
Zipcode*
Parent/Guardian's Home Phone*
Parent/Guardian's Work Phone
Parent/Guardian’s Email Address (if available, and if you want to receive progress reports that may be available from the course provider):*
Raleigh County has taken this step in order to be in compliance with federal legislation for child protection, including The Family Educational Rights and Privacy Act (FERPA -http://www.ed.gov/offices/OM/ferpa.html) and the Children’s Online Privacy Protection Act (COPPA http://www.ftc.gov/os/1999/9910/64fr59888.htm). All students using computers from school locations must agree to abide by school, county, and/or West Virginia Board of Education Policy 2460 (Educational Purpose and Acceptable Use of Electronic Resources, Technologies and the Internet). It may be viewed online at http://wvde.state.wv.us/policies/, or you may request a copy from your child’s school. It is the intention of the West Virginia Department of Education to filter and restrict access to controversial materials from school computers. However, since the online courses are web-based, content accessed from home or elsewhere outside the school could put the student in contact with objectionable materials via the World Wide Web. It is the responsibility of the parent/guardian of the student to restrict any access to materials deemed inappropriate by the parent/guardian.
This agreement, agreements ancillary to this agreement, and related documents entered into in connection with this agreement are signed when a party’s signature is delivered by email or other electronic medium. These signatures must be treated in all respects as having the same force and effect as original signatures.
Signature- To sign, use your finger, mouse, or stylus in the box.*

Clear
Please verify that you are human*
Should be Empty:

Application for Raleigh County Virtual Program

Raleigh County Virtual Consent Form- 2024-2025

A separate form must be completed for each child enrolling in the Raleigh County Virtual Program by Sunday, December 31st at 5:00 PM.