Southern Indiana Learning Academy Application

SILA | Southern Indiana Learning Academy Application

Welcome to SILA

Thank you for your interest in the Southern Indiana Learning Academy (SILA), a virtual learning program operated by Bloomfield School District.

SILA was created to provide students and families with a flexible learning option while maintaining high academic standards and meaningful support. Virtual learning can be an excellent opportunity for students who are motivated, organized, and supported at home. At the same time, it requires commitment from both students and families.

This application helps us learn more about your student, understand your family's goals, and determine whether SILA is the right educational fit. It also serves as an agreement between the student, parent(s)/guardian(s), and Bloomfield School District regarding expectations for participation in the program.

Completion of this application does not guarantee enrollment.

Student Information

Student Name

Current School

Date of birth

Grade Level

Address

Home Address

City

State

Country

Postal Code

Email Address *

Phone Number *

Parent/Guardian Names

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Student Goals and Interests

We want to understand why you are interested in virtual learning and what you hope to accomplish through SILA.

Why are you interested in attending Southern Indiana Learning Academy?

What are your educational, career, or personal goals?

What challenges do you think you may face in a virtual learning environment?

Family Support

Students are most successful when they have support from adults at home. Please tell us about the support system available to your student.

Primary Learning Coach/Support Person:

Learning Coach Name

Relationship to Student

Coach Phone

Coach Email

How will this person support the student?

Are there additional adults who will support the student?

Academic Readiness

Virtual learning requires students to take responsibility for their learning and stay engaged with coursework.

Have you participated in credit recovery?

Yes

No

Have you successfully completed online coursework before?

Yes

No

If yes, please describe your experience:

Have you failed any courses during the past two school years?

Yes

No

If yes, please explain:

Student Reflection

We would like to hear directly from the student.
In your own words, please explain:

• Why do you want to attend SILA?

• What are your goals for this school year?

• How will you stay motivated and engaged in a virtual learning environment?

Student Response:

Thank you for sharing this information with us. Your responses will help the Southern Indiana Learning Academy team better understand your student’s goals, needs, and readiness for virtual learning.

Completion of this application does not guarantee enrollment. A SILA representative may follow up with the parent/guardian to discuss next steps, program expectations, and any required orientation or enrollment steps.

By submitting this application, you confirm that the information provided is accurate to the best of your knowledge.

Southern Indiana Learning Academy is a public virtual K–12 program providing accredited, flexible education across Southern Indiana.

ENROLLMENT

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CONTACT

Address: 123 Cardinal Way, Bloomfield, IN

Phone: (555) 555-0123

Email: [email protected]

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