Virtual Education Application & Renewal

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2018-19 Virtual Education Program Application & Renewal Form

This form serves as the “letter of intent” for Wyoming school districts to seek approval to become virtual education providers as well as the renewal application for districts with programs approved in the previous school year. The form should be completed and submitted by the school district Virtual Education Coordinator.

School District *

Virtual Education Program Name (School District may be used if no specific program name) *

Brief description of the Virtual Education Program being proposed or renewed. Please include the main purpose for the program and the main method of course delivery. This description will be used on the Virtual 307 website and may be edited by the WDE as needed. *

Virtual Education Program Type (select all that apply) *

Full-time (more than 50% of a student’s education program)

Part-time (less than 50% of a student's education program)

Statewide (students may participate in the program regardless of where they live in the state)

District Level (only students who live in the district can take the virtual education courses being proposed or offered)

Other (regional area or other configurations besides district only or statewide)Other (regional area or other configurations besides district only or statewide)

Describe the program configuration

Virtual Education Program Grade Levels (select all that apply) *

Kindergarten

Grade 1

Grade 2

Grade 3

Grade 4

Grade 5

Grade 6

Grade 7

Grade 8

Grade 9

Grade 10

Grade 11

Grade 12

Link to Virtual Education Program website (if one exists)

Virtual Education Program Contact Name (This would be the person contacted for program information including course registration, completing an application for participation, etc. Typically this would be the same person identified as the Virtual Education Coordinator for the school district but it doesn’t have to be.) *

Virtual Education Program Contact Title *

Virtual Education Program Contact Email Address *

Virtual Education Program Contact Phone Number *

If different than the Virtual Education Program contact listed above, provide the contact information for the individual within the school district who assumes primary responsibility for the program (first and last name, position/title, email address and telephone number)

Tell Us About the Virtual Education Program Details

Program start date (first day of classes for the 2018-19 school year) *

Number of part-time students *

Number of full-time students *

The above estimate(s) are based on *

A needs assessment

Prior enrollment statistics

Number of part-time teachers *

Number full-time teachers *

Maximum allowed student to teacher ratios *

Teacher’s course load *

Teachers will be *

Employed by the school district

Employed by the vendor courses are purchased from

Employed by a combination of the school district and the vendor(s)

Proposed number of course offerings *

Curriculum Type *

Courses will be purchased from a vendor

Courses will be developed within the district

Combination of both purchased and district-developed

Name of virtual education course vendor(s) *

Description of course completion requirements, including for early completion prior to the end of the term. If course completion requirements vary by grade level or content area, provide that information. *

This is a *

Letter of intent to apply for a virtual program for the first time

Annual renewal application

Please upload the Virtual Education Statement of Assurance (if available)

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2018-19 Virtual Education Program Application & Renewal Form

Tell Us About the Virtual Education Program Details

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