OFFICIAL APPLICATION

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Primary Contact and Curriculum Observer Information

Relationship to Applicant(s)

Full legal name

First Name

Middle Name

Last Name

Suffix

Email Address

Telephone

Birthdate

Is the adult a U.S. Citizen?

Yes No

What is the adult's address?

Street Address

City

State / Province

Zip/Postal Code

Country

Tell us about the applicant.

Student's full legal name

Student's First Name

Student's Middle Name

Student's Last Name

Suffix

What gender is the student?

Male Female

Birthdate

Is the student a U.S. Citizen?

Yes No

What is the student's address?

Provide at least one adult with a complete address

What grade is the student applying for?

What enrollment status is the student applying for?

Full Time Part Time

Who will be the primary contact?

This is the parent who LUOA will be in contact with during the admissions process. Their contact information will be directly connected to the student's file in our system. Academic and financial information will be sent to this individual, including being assigned as the user to compete Financial Check-In for the student. Additionally, he/she will have access to the Student Onboarding Checklist and Course Registration. By selecting this role, you acknowledge that you have legal rights to enroll the student into LUOA.

Who will be the curriculum observer(s)?

Select Adult(s)

This is who will have access to the student's course material for the purpose of accountability and teacher interaction. This person's contact information will be indirectly connected to the student's file in our system unless also the Primary Contact. Additionally, he/she will have access to the student Onboarding Checklist and Course Registration. By selecting individuals for this role, you acknowledge that you have granted these rights once the student is enrolled in LUOA.

Has your student ever had an IEP or 504 plan?

Yes No

Agree & Submit

How did you hear about us?

I have read and agree to the Institutional Agreement & Technology Recommendations.

By submitting contact information through this form, I agree that Liberty University Online Academy and its affiliates may call me about its offerings by any phone number I have provided and may provide in the future, including any wireless number, using automated technology.

Visit for Terms & Conditions and Privacy Policy.

Yes No

Search incomplete apps by ID

Search incomplete apps by phone and/or email

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Primary Contact and Curriculum Observer Information

Student information

Tell us about the applicant.

Provide at least one adult with a complete address

Agree & Submit

How did you hear about us?