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Application Form Instructions

Welcome! Please read before starting your application.

Use a desktop computer.
Do not complete the application on a phone or tablet/iPad. A desktop provides the best user experience.
Account creation after submission.
Once your application is submitted, accounts will be created for both the parent/guardian and the student. Emails will be sent with login information. Please only use the parent/guardian account access in the Genius Parent Portal.
Applying for additional students.
If you have more students to enroll, you can apply for them after accessing your account. Select “Create New Application” from the dropdown menu at the top of the page. A separate account will be created for each student, and user access emails will be sent for each additional student.
Laptop and technology requirements.
Please review the Technical Requirements for Online Learning (see pages 4–5) to ensure your devices meet the necessary specifications.

Thank you for choosing Optima Academy Online!

If you need assistance, please contact admissions at [email protected]

Student Information

First Name *

Last Name *

Middle Name

Gender *

Date of Birth *

Entering Grade Level (0 is Kindergarten)) *

How did you hear about us? *

Which course types are you most interested in? *

What has been your student’s prior education affiliation? *

If 'Other' is selected for prior education, please specify here.

How do you plan to enroll your child? *

Mailing Address (if different from Physical Address-Street, City, State, ZIP):

Has the student previously attended Optima Academy Online? *

Which scholarship will you be using? *

What school year do you plan to enroll? *

What state does your student live in? *

Which of these best describes your family's current need? *

If your student previously attended OAO, in what year did they attend? *

Does the student have a sibling currently enrolled at Optima Academy Online? *

Are you a parent or guardian applying who is currently employed by OptimaEd or Optima Academy Online? *

Please provide the sibling’s full name(s) and grade level(s):

Do you plan to grant access/release student information to a third party (coach/facilitator) to support coursework? (A notarized form will be required; we will provide more information.) *

Who will be the student’s at-home learning facilitator (the adult helping guide their daily learning)? *

Facilitator phone number (call/text) *

If a friend or family member referred you to Optima Academy Online, please list their full name and email so they can receive referral credit.

How many courses do you plan to enroll your student in? *

High School Students Only - As your student enters high school at Optima Academy Online, we would like the ability to communicate directly with both you and your student. Supporting direct communication with students helps encourage the virtues of responsibility and self-governance. Do you give Optima Academy Online’s teachers and staff permission to communicate with your student regarding course assignments, due dates, and important schoolwide updates? (You will be CC’d on all communication.)

Address

Street *

City *

State *

Country *

ZIP *

Student Email (Guardian email if no student email) *

Country of Birth *

Citizenship

Hispanic or Latino *

Primary Contact Phone # *

Birth City *

Birth State *

Residing County (Physical Address) *

Race *

Primary Parent/Guardian Information (With Whom the Student Resides)

Relationship *

First Name *

Last Name *

Email *

Phone *

Alternate Parent/Guardian Information

Relationship

First Name

Last Name

Email

Phone

Additional Information

Local School District of Residence: *

When did your child first attend a U.S. school? (Kindergarten or later) *

Have you moved recently to find agricultural, fisheries, or dairy work? (Y/N) *

If your child has attended a U.S. school for less than 3 full years, what date did they enter? (Required if applicable)

What is your language preference? *

If the preferred language is 'Other,' what language is preferred?

Who does the child live with? *

Is there a power of attorney? (Y/N) (If yes, please provide documentation.) *

If there is a parenting plan or custodial agreement requiring legal documentation, if yes, please provide? (Y/N) (If not, please provide proof of custody.) *

Is there a court order barring either parent? (Y/N) (If yes, please provide documentation.) *

Does only one parent have final decision-making authority regarding educational decisions for the student? (Y/N) (If yes, indicate the name of the parent and provide a copy of the court order stating this authority.) *

Is there a restraining order or court order that restricts or impacts access to the student by anyone, including a parent? (Y/N) (If yes, please provide documentation.) *

Is your child a member of an active military family? (Y/N) *

Is your family residing in any of the following situations? *

Has your child ever been identified to have any of the following Exceptionalities? (Select all that apply) ?? If you select any option below, please upload the corresponding documentation (e.g., IEP, 504 Plan, evaluation report, or medical documentation) to support your selection. If you do not have any documentation at this time, please refrain from selecting any options. *

If "Other" was selected, please indicate which exceptionalities your student has.

Was your child in an Exceptional Student Education (ESE) with one of the following plans: IEP, 504, or EP program at their previous school? (Y/N) (If yes, please upload relevant documents.) *

Was your child in an ELL (English Language Learners) program at their previous school? (Y/N) (If yes, please upload relevant documents.) *

Does the student have any previous school expulsions? *

If 'Yes' for previous expulsion, please identify the school(s) and date(s).

At this time, is your child under an expulsion or alternative placement order? *

If 'Yes' for current expulsion, please identify the school(s) and date(s).

Has your child ever had any referrals to mental health services? (Y/N) *

If 'Yes', provide details of any referrals to mental health services, including instances and dates.

Has your child ever been arrested resulting in a charge or juvenile justice action? (Y/N) *

If yes, explain the reason for the arrest and direct to the School Counselor.

List previous school attended (Name, Address, Phone Number, , From Date, End Date, Grade Completed). *

List Emergency Contact Information (Name, Phone Number and Email Address). *

Is the Primary Home language English? *

If 'No', specify the language.

Did the student have a first language other than English? (Y/N) *

If yes, specify the language.

Does the student speak a second language? *

If yes, specify the language.

Do you acknowledge that by selecting a language other than English on any of the above three Home Language Survey questions, your child will be temporarily placed in the ESOL Program pending testing, regardless of whether 'Yes' or 'No' was selected for any of the questions? *

Relationship to the student of the person completing this Home Language Survey: *

Signature of the person completing this Home Language Survey: (By filling in your name below, you acknowledge that the information provided is accurate.) *

Date signing this: *

By selecting 'Yes,' you understand and agree that Optima Academy Online may occasionally show G and PG-rated films. If you prefer that your child not view G or PG-rated films, please select 'No.' *

Do you acknowledge receipt of the Photography/Videography Notice and grant the academy permission to capture, use, or share photographs, likenesses (including avatars), and/or quotations of your child as deemed appropriate by the academy? This may include images or videos from academy events, classroom activities, and student recognition. Please select 'Yes' or 'No. *

By signing and dating this application, you confirm that the information provided is true, accurate, and complete to the best of your knowledge. Your signature serves as acknowledgment of the details included in this application. *

Submission Date *

Do you have a laptop or desktop computer with a working webcam and reliable internet access that meets the school’s minimum technical requirements for online learning? (Minimum technical requirements are provided in the application instructions.) *

Welcome to the Application Form

Student Information

Address

Primary Parent/Guardian Information (With Whom the Student Resides)

Alternate Parent/Guardian Information

Additional Information