NVA Application Form

Student Info

Student Name*

First Middle Last

Home Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Gender*

Male
Female

Grade Level*

GPA*

Graduation Year*

Birthdate*

Special Academic Considerations*

None
Limited Language Proficiency
IEP
504

Check all below that apply.

Parent Name*

First Last

Parent Phone*

Parent Email*

School Info

School Name*

School City, State*

School Phone*

Advisor Name*

First Last

Advisor Email*

Course #1 Info

Course #1*

Select course from the alphabetical drop-down list. MS and test prep courses are at the end of the list.

Course #1 Pace*

Traditional (1 cr = 36 wks; .5 cr = 18 wks) : Accelerated (1 cr = 18-24 wks; .5 cr = 9-12 wks)

Traditional
Accelerated

Is Course #1 a specific semester of a course?

If so, select First or Second semester below. If not, leave blank.

First Semester Only
Second Semester Only

Is Course #1 for Credit Recovery?*

Only specific courses are available as Credit Recovery. See Course Listing.

Yes
No

Course #1 Start Date*

Courses only begin on Mondays. This form and payment must be received by the Tuesday before the proposed start date.

Course #2 Info

Course #2*

Select course from the alphabetical drop-down list. MS and test prep courses are at the end of the list.

Course #2 Pace*

Traditional (1 cr = 36 wks; .5 cr = 18 wks) : Accelerated (1 cr = 18-24 wks; .5 cr = 9-12 wks)

Traditional
Accelerated

Is Course #2 a specific semester of a course?

If so, select First or Second semester below. If not, leave blank.

First Semester Only
Second Semester Only

Is Course #2 for Credit Recovery?*

Only specific courses are available as Credit Recovery. See Course Listing.

Yes
No

Course #2 Start Date*

Courses only begin on Mondays. This form and payment must be received by the Tuesday before the proposed start date.

Payment Info

Total each type of course listed above and input quantity next to the appropriate below fields. If none, leave blank.

One time Registration Fee per student

Input 1 if this is the first time you have registered for a course with NVA. Leave blank if you have registered for a course previously.

Price: $35.00

Standard 1 credit courses

Price: $625.00

Standard .5 credit or single semester courses

Price: $485.00

AP 1 credit courses

Price: $725.00

AP .5 credit or single semester courses

Price: $585.00

Credit Recovery courses

Price: $399.00

Total Due

$0.00

Payment Method

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Student Info

School Info

Course #1 Info

Course #2 Info

Payment Info

If form does not submit, scroll to top of form to locate missing required fields, complete, then resubmit