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K'nextions Learning Academy Student Information Form
KLA School Year Registration Form
To be completed by Guidance Counselors only

Please complete 1 form for each student you wish to register for the KLA online learning program.  

You will receive a confirmation email upon submission. 

Select Your District (If your district is not listed please type the district name in the additional information box at the end of this form)













Counselor Name:
Was this student previously enrolled in KLA?
Student's First & Last Name:
Please select student's grade level







Parent/Guardian Name:
Parent/Guardian Mailing Address
Parent/Guardian Phone:
Parent/Guardian Email:
List required courses. Please be specific. Include full or half credit requirements per course. (example: Algebra I, half or full credit, semester A or B or both)
Is the student on an IEP? (If yes, please email a copy of the IEP to kla@lakeesc.org and include the students name in the subject line)
Only answer if you answered yes to is this student on an IEP. Is student approved to attend KLA online learning by your Special Ed Director?
Is the student on a 504? (If yes, please email a copy of the 504 to kla@lakeesc.org and include the students name in the subject line)
Only answer if you answered yes to is this student on an 504. Is student approved to attend KLA online learning by your Special Ed Director?
Please provide any additional information on this student.
Your Name:
Your Email:

To validate your submission, please answer the following math problem:

captcha question
Lake County Educational Service Center

8221 Auburn Road, Concord Township, Ohio 44077
Phone: 440.350.2563
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