Application for Full Time Enrollment (VDLP)

Please complete the following information and submit. To expedite the enrollment process, complete all fields before you submit. Fields that do not apply may be left blank. For example, if there is no cell phone, it may be left blank. The student and parent should complete the form together.

Personal Information
Student legal first name
Student middle name
Student legal last name
Student last name extension if any (Jr., III)
Last name student goes by
What school year did/will the student first begin 9th grade?
Current grade 2011 - 2012
Gender
Date of birth (mm/dd/yyyy)
Ethnicity - Hispanic/Latino (select yes or no)
Race
- White
- Asian
- Black or African American
- American Indian or Alaskan Native
- Native Hawaiian or other Pacific Islander
What is the primary language used in the home regardless of the language spoken by the student?
What is the language most often spoken by the student?
What is the language that the student first acquired?
Student email address
Address
Street AddressAddress Line 2CityStateZip Code
Home phone
Student cell phone
Home Dwelling
Student city/town of birth
Student state of birth
Student country of birth

Course/General Information
How did you hear about our program?
Computer that will be used
Type of internet connection
- Dial-up
- Cable/DSL
What courses are you interested in taking?

I understand and agree that... - I will maintain a steady progress through my coursework. - A minimum of five hours per week per course is required for a timely course completion. If I fail to log on for three weeks or do not show progress within a reasonable amount of time, I may be dropped from the program. If I am withdrawn from my course or I do not complete the course within the allotted time, tuition fees may apply to any re-enrollment. - I am responsible for taking any Arizona state mandated tests required for my grade level (i.e, AIMS, Stanford 10). By law, I will be dropped from all courses or be required to pay tuition, with no exceptions, if I do not attend state testing. Part-time students should check with their district for test dates and times. Test dates and times for full-time students will be posted on the main website and will be emailed to students and parents. - I will use appropriate communication when contacting teachers or office staff. I will not forwarded any mail other then course related work to teachers and office staff. - Any student found plagiarizing work for a course will be subject to failing grades for the plagiarized assignments, and may be dropped from the course and/or program. Plagiarism is defined as the unauthorized use or close imitation of the language, thoughts, or writings of another author (or student). Plagiarism includes, but is not limited to, cutting and pasting from any source, borrowing information without citing the original source, copying another student's assignments, or using another student's answers as your own. Due to the individualized nature of our program, students are expected to work independently on all quizzes, tests, practice/homework, online content, labs, journals, essays, etc. that are assigned in the course.
I have read and understand that... - Students must request and be granted permission online to take final exams. Once a student requests an exam, an approval or permission denied message will be emailed to the student and parent. Students who have not been granted permission electronically will not be allowed to take a final. - Final exams are administered by an approved proctor. To maintain their integrity, online tests are timed and randomized. - To receive credit for an online course, students must pass the final exam with a 60% or better, regardless of their current cumulative course grade. Students who fail the final exam (less than 60%) will receive a failing grade.
I have read and understand that... Student must not: - plagiarize material on the Internet or other source. - use the Internet or other source while taking an exam or at other times when instructed not to do so. - access, transmit or post material that is threatening, abusive, obscene, sexually explicit, or vulgar. - disrupt or harm the district's computers, network, or Internet service. - misuse the password or access the account of another student or teacher.
- I have read, understand, and agree to maintain the minimum requirements for enrollment in the online learning program. If I do not comply with the minimum requirements, I agree either to pay for each online learning course in progress or otherwise completed during the current academic school year, or forfeit all credit/s acquired during the academic school year.
- I do NOT agree to the minimum requirements.
Name of
Name of student

Application for Full Time Enrollment (VDLP)

Application for Full Time Enrollment (VDLP)

Personal Information

Previous School Information

Parent Information

Parent(s) NOT in the home:

Course/General Information

Credit Recovery

ACT Prep

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