Remote Learning Request

Student First and Last Namerequired

Student ID Numberrequired

Parent/Guardian First and Last Namerequired

Parent/Guardian Email Addressrequired

Parent/Guardian Phone Numberrequired

Please select the reason of requesting remote learningrequired

Please select the start date.required

Must contain a date in MM/DD/YYYY format. Valid range: Aug 3, 2026 or later

Please add the end date. (If it is one day - enter the same date as the start date. If more than one day, the dates must be consecutive.)required

(Must contain a date in MM/DD/YYYY format). Valid range: Aug 3, 2026 or later

*If applicable and when prompted* Please upload any supporting documents.

Attach up to 1 file with a maximum size of 10MB

No file chosen

Pre-Approval Forms, Doctor's Excuses, etc...

Please note: By filling out this form, you are advising Vickery Mill that your student wishes to attend school remotely and why. This does not mean all excuses are acceptable or that all requests are approved. A school administrator will be in touch with you to provide an answer to your request. Thank you!

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