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Enrollment Packet

Step 1 of 9

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  • South Central Michigan Virtual Enrollment Form

  • Student Information

  • (As it appears on the birth certificate - first name, middle name, last name)
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  • (If more than one, check all that apply)
  • Name of Parent of Guardian Student Lives With

  • Special Education Information


  • School of Choice Information

  • (mm/yr)

  • Contact Information


  • Female Head of Household Contact Information


  • Male Head of Household Contact Information


  • Certification of Truthfulness - I certify that all statements on this student registration form are made truthfully and without evasion, and further understand and agree that such statements may be investigated and if found to be false, will be sufficient reason for possible removal of this student from enrollment in the Jackson Public School District and may result in legal action.

  • MM slash DD slash YYYY
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  • 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.

  • MM slash DD slash YYYY
  • 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.

  • Indicate which documents you will upload to display the field for each - one file per field
  • Max. file size: 10 MB.
  • Max. file size: 10 MB.
  • Max. file size: 10 MB.
  • Max. file size: 10 MB.
  • Max. file size: 10 MB.
  • Max. file size: 10 MB.
  • Max. file size: 10 MB.
  • Max. file size: 10 MB.
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  • School of Choice Form

  • Applicant Information

  • MM slash DD slash YYYY

  • Parent Information

    • Transportation will be the responsibility of the applicant/parent/guardian
    • Michigan High School Athletic regulations apply to all transfers involving high school age students
    • Applications can only be made to one K-12 school district within the Jackson County Intermediate School District
  • MM slash DD slash YYYY

  • 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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  • 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.

  • MM slash DD slash YYYY
  • MM slash DD slash YYYY

  • 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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  • McKinney-Vento Homeless Assistance Form

    This section is intended to address the McKinney-Vento Homeless Assistance Act under the guidelines of the Every Student Succeeds Act (ESSA), 2015. Your answers will help the administrator determine the supplemental needs of the student. (Complete one form per student.)

  • If none of the options apply, skip to the next page.
  • MM slash DD slash YYYY
  • MM slash DD slash YYYY

  • For any choices selected in the first question of this section, this form must be completed and faxed to JPS Homeless Liaison (Mrs. Willye Pigott) immediately after completion. Original forms are kept (in the school) separate from the student's CA 60 for audit purposes during the school year.

    Name and phone number of a school contact person who may know of the family's situation:

    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.

  • 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.

  • 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.

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  • 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

  • MM slash DD slash YYYY
  • 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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  • How Did You Hear About Us?

  • Please check all that apply.
  • Please describe how you heard about us.
  • This field is for validation purposes and should be left unchanged.
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