Enroll

South Central Michigan Virtual (SCMV) makes the enrollment in online classes easy. Once enrolled, students will be paired with an academic counselor who will build a curriculum specifically tailored for your Jackson County student.

How To Enroll

There are just two steps in the enrollment process:

Complete an SCMV enrollment application online (or download the application)
Provide supporting documentation

Step 1 of 9

Residency Verification Affidavit
SECTION ONE: Please read below and complete

According to State Attorney General Opinion No. 5925, school districts have the right to request proof of pupil residency. By signing this affidavit, you are affirming that the address given on all enrollment forms is the legal residence of the parent or guardian enrolling the student and is the residence of the student. If you are living in the home of another person without a rental or lease agreement, that person must sign this document and prove their residency.
Student Name*
First Last
Street Address*
Street Address City State ZIP Code
Signature of Parent or Guardian*
Date*
MM slash DD slash YYYY
Signature of Person With Whom Residing (If Applicable)
Date
MM slash DD slash YYYY
SECTION TWO: Please provide (2) of the following:
- Driver's License
- Lease Agreement
- Utility Bill
- Voter Registration
- Passports - Michigan Residents
- State I.D.
- Michigan Income Tax Return
The next section of the form will allow you to upload documents.
SECTION THREE: Please read and complete if applicable

If you are NOT a resident of the JACKSON PUBLIC SCHOOL DISTRICT please complete the School of Choice form (otherwise, you may skip that section.)

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Upload All Supporting Documents

Please upload any documents needed for the previous sections of this form.
Documents I'll Upload
Indicate which documents you will upload to display the field for each - one file per field
- Select All
- Driver's License
- Lease Agreement
- Utility Bill
- Voter Registration
- Passports - Michigan Residents
- State ID
- Michigan Income Tax Return
- Other
Driver's License*
Max. file size: 10 MB.
Lease Agreement*
Max. file size: 10 MB.
Utility Bill*
Max. file size: 10 MB.
Voter Registration*
Max. file size: 10 MB.
Passports - Michigan Residents*
Max. file size: 10 MB.
State ID*
Max. file size: 10 MB.
Michigan Income Tax Return*
Max. file size: 10 MB.
Other*
Max. file size: 10 MB.

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Jackson Public Schools
Michigan State Board of Education
Approved Home Language Survey

The Jackson Public Schools, as required by Federal and State Laws, is collecting information regarding the language background of each of its students. This information will used by the district to determine the number of children who should be provided bilingual/second language instruction according to Sections 380.1152-380.1157 of the School Code of 1995, Michigan's Bilingual Education Law. Please provide the following information.
Full name of student*
First Last
Gender*
- Male
- Female
Date of Birth*
MM slash DD slash YYYY
Country of Birth*
Year of entry in US School*
School Building*
Grade*
Is your child's native tongue a language other than English?*
- Yes
- No
What is the language?*
Is the primary language used in your child's home or environment a language other than English?*
- Yes
- No
What is the language?*
Signature of Parent/Guardian*
Date*
MM slash DD slash YYYY
Parent or Guardian Address*
Street Address City State ZIP Code
Telephone where you can be reached*
Thank you for your cooperation.

NOTE: Translation of this survey form in Spanish, Japanese, Chinese (Mandarin), Polish, and Vietnamese is available at Jackson Public School's Reynolds Hall, 522 Wildwood Ave., Jackson, MI 49201. If completing a printed form, please return form to your school office.

SCHOOL OFFICE USE ONLY: If the parent/guardian has checked YES for Question 1, this completed form must be faxed immediately to the attention of the ELL Coordinator at 768-5918. The original form is to be kept at the school in the student's CA-60 for audit purposes during the school year.

It is the policy of the Jackson Public Schools District that no discriminatory practices based on sex, race, color, national origin, religion, height, weight, marital status, handicap, age, political affiliation, sexual orientation, or disability or any other status covered by federal, state, or local law be allowed in providing instructional opportunities, programs, services, job placement assistance, employment, or in policies governing student conduct and attendance. Any person suspecting a discriminatory practice should contact the Human Resources Office at Jackson Public Schools, 522 Wildwood Avenue, Jackson, Michigan 49201 or call (517)841-2153.

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Technology Contract

South Central Michigan Virtual is dedicated to making your education a fulfilling and pleasurable experience. We will continue to provide you with enhanced technology throughout your educational path while enrolled at SCMV.
Student Name*
First Last
Grade*
Parent / Guardian Name*
First Last
By signing below, we understand that:
- SCMV operates virtual education programming. This document authorizes the opportunity for students to take virtual courses when enrolled at SCMV.
- All technology distributed to me or my child is property of SCMV.
- All technology must be returned in good working order within 10 business days of completion or termination from program.
- Any programs or websites that are not related to SCMV curriculum are prohibited on SCMV devices.
- All SCMV devices are remotely controlled, tracked, and monitored.
- We are responsible for any damages to SCMV technology equipment that is not normal wear and tear.
- We are responsible for the cost of replacement of SCMV technology that is lost or stolen.
- We are responsible for the cost of replacement of SCMV technology if equipment is not returned within 10 days of completion or termination from program.
- We agree to be a responsible digital citizen. I or my child will not submit, publish, display, or retrieve any defamatory, obscene, racially offensive, or illegal material.
- We will not participate in cyber bullying and will report any instances of cyber bullying to SCMV representative.
We acknowledge that we have reviewed this agreement together and understand our responsibilities.
Student Signature*
Date*
MM slash DD slash YYYY
Parent / Guardian Signature (if under 18 years old)*
Date*
MM slash DD slash YYYY
If you have any questions or concerns regarding SCMV technology please contact Amy Barton. amy.barton@jpsk12.org or 517-841-2822.

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Request for Student Records
Name of Student*
First Last
Date of Birth*
MM slash DD slash YYYY
Grade*
Name of Previous School*
Phone*
Address*
Street Address City State ZIP Code
Parent / Guardian / School Official Signature*
Date*
MM slash DD slash YYYY
Under the provisions of the Federal Educational Rights and Privacy Act, Federal Register, Volume 41. NO. 118, June 17, 1976, it is no longer necessary to have written consent of the parents to release records. School officials, including teachers within the educational institution and officials of other school systems in which the student intends to enroll, may request student records.

Please Fax Transcript ASAP to: 517-990-0002

Please include cumulative school records, health records, test scores, psychological reports, special education records, etc. Any additional information you can give us to help in proper placement will be appreciated. Send all confidential and cumulative student records (CA60) to:

South Central Michigan Virtual
ATTN: Amy Barton, SCMV Secretary
1060 Jackson Crossing
Jackson, MI 49202
Email: amy.barton@jpsk12.org
Fax: 517-990-0002

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Have questions? Request more detailed information about the enrollment process.

Enroll

How To Enroll

Step 1 of 9

South Central Michigan Virtual Enrollment Form

Student Information

Contact Information

Residency Verification Affidavit

Upload All Supporting Documents

School of Choice Form

Applicant Information

Parent Information

Jackson Public Schools
Michigan State Board of Education
Approved Home Language Survey

McKinney-Vento Homeless Assistance Form

Technology Contract

Request for Student Records

How Did You Hear About Us?

Enroll

How To Enroll

Step 1 of 9

South Central Michigan Virtual Enrollment Form

Student Information

Contact Information

Residency Verification Affidavit

Upload All Supporting Documents

School of Choice Form

Applicant Information

Parent Information

Jackson Public SchoolsMichigan State Board of EducationApproved Home Language Survey

McKinney-Vento Homeless Assistance Form

Technology Contract

Request for Student Records

How Did You Hear About Us?

Jackson Public Schools
Michigan State Board of Education
Approved Home Language Survey