Student’s First Name(Required)Student’s Middle InitialStudent’s Last Name(Required)Student’s Preferred First NameStudent’s Preferred Gender(Required)MaleFemaleNon-BinaryOtherPrefer Not to AnswerStudent’s Date of Birth(Required) MM slash DD slash YYYY Student’s Home Address(Required) Street Address City State / Province / Region ZIP / Postal Code Student’s Grade Level for the 2026-27 School Year(Required)Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th GradeStudent’s Current School(Required)Parent/Guardian’s First Name(Required)Parent/Guardian’s Last Name(Required)Parent/Guardian’s Telephone NumberParent/Guardian’s Email Address(Required) Parent Preferred Contact Method (check all that apply)(Required) Phone Call Email Text Parent/Guardian’s Mailing Address (if different from student’s) Street Address City State / Province / Region ZIP / Postal Code Which UP RVA Program is the student interested in? (Check all that apply)(Required) Middle School High School How did you hear about UP RVA?(Required)Friend/Family MemberTeacher/EducatorCurrent/Past UP RVA Student/FamilySocial MediaPrint/TelevisionWebsiteCommunity EventUP RVA Admissions EventOtherPlease explain how you heard about UP RVAIs there any other information you would like to share?By filling out this form, you agree to receive emails from UP RVA regarding our admissions process and programming Δ
