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K'nextions Learning Academy Student Enrollment 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 do not use this form - email [email protected])










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 course(s) including: COURSE NAME, SEMESTER (if applicable), CREDIT (example: English 9 A half (0.5) credit) *PLEASE contact KLA regarding World Languages
Is the student on an IEP? (If yes, please email a copy of the IEP to [email protected] 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 [email protected] 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.
Please provide any specific completion dates for course(s) which you have agreed on with your student. For example: Algebra 1/A must be complete by 9/30/19.
Your Name:
Your Email:

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

captcha math problem
Educational Service Center of the Western Reserve

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