Sunday & Holidays closed
You may print out this Application
Remember you are enrolling in an online program all work will be in the Privacy of your home unless arranged by the School If you are interested in the SIMPLE PACE PROGRAM, SHORT TERM PROGRAM, or PARENT GUIDED PROGRAM please complete the application below, and indicate by checking the application box. There is a separate application for the special needs student and rapid pacestudent program.
( ) Simple Pace Program ( ) Short Term Program ( ) Parent Guided Program
JOHNSON SECOND CHANCE - VIVIAN'S DIGITAL LEARNING ACADEMY, LLC
Student Application Form. Please use one Student Application Form for each child you are enrolling.
Student Information: * Required Fields
Student’s First Name * ________________________Student's
Middle Initial ____ Student's Last Name ____________________________________
Birthdate* mo/day/yr _______________________________________________
Gender* Male ( ) Female ( )
Last Grade Completed* K 1st ( ) 2nd ( )3rd ( )4th ( )5th ( )6th ( )7th ( ) 8th ( ) 9th ( ) 10th ( ) 11th ( ) 12th
Current Grade* K 1st ( ) 2nd ( )3rd ( )4th ( )5th (
) 6th ( ) 7th (
)8th ( )9th ( )10th ( )11th ( ) 12th
Please enter any pertinent information concerning your child
and his/her educational needs
Previous School Information:
Last School Attended* ________________________________________________________________
City * _____________________________________ State*____________ Zip Code _________________
Last Date Attended (Approx.) * _______________________________
American Indian or Alaskan Native ( )
Asian ( )
Black or African American ( )
Hispanic or Latino ( )
Native Hawaiian or Pacific Islander ( )
White ( )
Other ( )
Enter N/A in any field for a person that is not living in the home.
Father’s First Name* ________________________________Father's Last Name______________________________
Father's Relation to Student*
Father ( )
Step-Father ( )
Guardian ( )
Mother’s First Name * _____________________________Mother's
Last Name* _____________________________
Mother's Relation to Student *
Mother ( )
Step-Mother ( )
Guardian ( )
Marriage Status of Parents:*
Married ( ) Single Parent ( ) Divorced ( ) Domestic Partners ( ) Separated** ( )
**If separated, both parents/guardians must sign the Parent Agreement at the bottom of this form. The other parent may give consent by email.
Shipping Address * Not a Post Office Box
City* _______________________________ State * _________________ ZIP Code*_________________________
Mailing Address *
City* _________________________________ State * _________________ ZIP Code * ________________________
Home Phone* Cell Phone ______________________________________
Use numbers only......... Example: 7714445512 ........No dashes & No ( )
Work Phone Ext. Mother's Father’s _________________________
Email Address * If none, type "None" ____________________________________________________________
Do you have a High Speed Internet connection? Yes ( ) No ( )
Please indicate if you prefer computer-based curriculum or workbook-style curriculum. There are advantages to both. You may even combine the two. In any case. You may want to call and discuss the advantages of either with one of our Education Specialists. Remember, there is an extra cost for the computer-based curriculum and is only available in the Full Year Payment option. The extra cost will be stated by the curriculum company used per course per year.
Computer-based - If so, what type of required back-up do you have for your computer? ie: USB Hard Disk Drive, Thumb Drive, Carbonite, Mozy, Barracuda
Combination of Workbook-style and Computer-based - If so, what type of required back-up do you have for your computer?
ie: USB Hard Disk Drive, Thumb Drive, Carbonite, Mozy, Barracuda
Total Registration Fee: _____________________
.Registration Fee: (One Time Fee)..(Choose one)......................................$20.00 *
1. K - 5th grade (Includes Diagnostic Testing & Placement): $20.00 or
2. 6th - 12th (9th & 10th includes Diagnostic Testing & Placement): (see this web site for testing prices
We now offer and require either of the following major norm-referenced tests include the California Achievement Test, Iowa Test of Basic Skills, Stanford Achievement Test, and Terra Nova.)
Total Tuition Fee: ______________________
Tuition Fee: (See Registration & Fees for options)...................................
Total Fees: _______________
Total Fees (Add Registration & Tuition Fees)............................................. *
You may confidently e-mail this Application with your credit card information. If you are not submitting card information, type N/A in each field. JAVACCS, LLC. Does not accept personal checks.
Type of card: VISA ( ) MASTERCARD ( )
Account # *___________________________________________________
Expiration date * _________________________ Security code *_______________________________
Name on Account * ________________________________________________
Billing Address * _________________________________________________
City * ___________________________ State * ______________________ ZIP Code * _______________________
* Required Fields
Parent Agreement Form
We have reviewed the Student Application and to the best of
our knowledge, all information provided is complete and accurate.
We understand that we are responsible for the tuition payment, which provides for all necessary curriculum assignments, parent answer keys, report cards, and permanent record file. We further understand that some courses require reference books, which are an extra cost. We understand that the application fee is a one-time payment and is non-refundable. We have read and understand the refund policy of the School.
We understand that a school year is a maximum of 12 months, beginning on the date of enrollment and ending when the student has completed all curriculum assignments. If enrolling from another school during a school year, we understand that the school year start date is the start date of the previous school and curriculum assignment adjustments will be made by the JSCS-VDLA staff.
We understand that if we choose the quarter tuition payment, it provides for (1/4) one quarter of the school year of materials and should be completed within (3) three months. We understand that a student is placed on the Inactive Roll if we do not send another tuition payment within the three month period and that a Reactivation Fee of $5.00 will be assessed to reactivate our child in the School. We further understand that if we do not reactivate our child within (3) three months of his/her Inactive Roll status, our child will not be allow to return to the Active Roll of this School and we will need to seek other educational alternatives. We also understand that if our child is placed on the Inactive Roll more than (2) two times and accumulates more than (4) four months of Inactive Roll status in one school year, our child will not be allowed to return to the Active Roll of this School and we will need to seek other educational alternatives. We further understand that if completed assignments are returned after exceeding the Reactivation deadline, the School will assess an Extension Fee of $25.
We understand that if we choose the full year tuition payment, it provides for one school year of materials and should be completed within (12) twelve months. We understand that a student is placed on the Inactive Roll if we do not send another tuition payment within the twelve month period and that a Reactivation Fee of $5.00 will be assessed to reactivate our child in the Academy. We further understand that if we do not reactivate our child within (3) three months of his/her Inactive Roll status, our child will not be allowed to return to the Active Roll of this Academy and we will need to seek other educational alternatives. We further understand that if completed assignments are returned after exceeding the Reactivation deadline, the School will assess an Extension Fee of $25
We understand that our child is to be under direct adult supervision during study time at your home or at our designated site, and that the supervising adult has read and understands the School procedures. We further understand that the supervising adult will require that the student adhere to the School procedures, including, but not exclusive of, copying answers from the Score Keys or Test Keys and by keeping the Test Keys in a secure location. We agree to submit completed and graded Tests at the end of each semester term. We understand that Johnson Second Chance - Vivian's Digital Learning Academy, reserves the right to withhold grades and credits of any student that is found to be in non-compliance of School’s procedures and policy.
We understand that if we are using the computer-based curriculum that we are required to have a back-up disk for the data and that the back-up of the data will be performed on a weekly basis at least. We further understand the requirement of anti-virus software and will ensure that the anti-virus software is updated daily.
By entering our names in the Signature boxes, we understand
and agree with the above statements and also verify the information entered is
correct to the best of our knowledge. We now offer and require either of
the following major norm-referenced tests include the California Achievement
Test, Iowa Test of Basic Skills, Stanford Achievement Test, and Terra Nova
Student's Signature: * ______________________________________________________________________
Father / Guardian Signature: * _______________________________________________________________
Mother / Guardian Signature: * _______________________________________________________________
Name of Parent, Guardian, or Supervisor responsible to
administer this home school program:
If this is a person other than the Parent or Guardian, please provide the relationship to the student:
If desired, please list the names of any other relatives or
non-family persons and their relationship to the student, with whom the
student's Academic Advisor may discuss the student's academic information
(tutors, grandparents, noncustodial parent, etc.).
Name _________________________________________ Relationship ________________________________
Follow link to pay for courses www.myjavaccs2.com
JOHNSON SECOND CHANCE – VIVIAN’S DIGITAL LEARNING ACADEMNY, LLC
IS LOOKING FOR YOU!!!
If you have a compassion for helping others and time to volunteer four hours (4) a month to help offer administrative, instructional activity, and monitoring of the school then please apply. Must be supportive of the CEO. Believe in the mission, purpose, vision, and goals of the school and consultant firm; must have the qualifications of leadership in the following categories, please go to our web site and fill out the application and mail it to us for an interview. (www.johnsonsecondchanceschool.com or www.vivianslearningacademy.com. We will be interviewing at the High meadows library every second Tuesday of each month and every third Thursday of each from 4:00p.m. to 7:00p.m in the conference room. See you there!!!
Seeking position of: (see criteria below for all positions)
Board of Directors for JOHNSON SECOND CHANCE - VIVIAN’S DIGITAL LEARNING ACADEMY must participate in board meetings, and decisions making for the school. Contribute once a year to the school and consultant firm
Instructional Leader: Oversee career counseling programs.
School Supervisors: Prepare budgets, and responsible for fund raising. Must have a bachelor’s degree and people oriented skills, knowledgeable with day-day- operations of a school or religious environment.
Department heads or chairpersons are in charge of departments that specialize in particular fields of study, such as English, biological science, or mathematics.
Principals and assistant principals Coordinating and interacting with faculty, parents, students, community members, business leaders, and State and local policymakers.
K-12 teachers and counselors Prefer retired highly qualified teachers (educators) in any content area or otherwise specified for students in a specific content area of need. Must be able to communicate with parents, students, and community leaders. Be a leader and role model for students. Positive motivator and encourager
Note: a schedule and a contract of agreement will be offered signed and accepted by all and the Director of JOHNSON SECOND CHANCE - VIVIAN’S DIGITAL LEARNING ACADEMY bearing company seal and stamp.
Dedicated to the students at Hall High School, Aldine ISD, 2015-2016 and Johnson Second Chance-Vivian's Digital Learning Academy, LLC
For more information on us or call us at 281-441-2640
MESSAGE FROM THE CEO
Johnson Second Chance School-Vivian Digital Learning Academy, LLC continue to offer caring, talented teachers, and the latest technology. We are dedicated in offering our students a personalized and engaging online school environment that helps children, teens, and adults thrive and obtain their goals and are successful. Our schools are a strong foundation for a future full of opportunity.
OUR TEACHERS YOU ARE APPRECIATED