I-Virtual High

Form for Online Course Only (DE101)
*Is a required field

Step 1

*Student First and Last Name

* DOB: mm/dd/yyyy

*Address, City, Zip
, , CA

* Phone + Area Code

* Cell/Other + Area Code

* High School Student Attends:

* Student e-mail:

* Parent e-mail:

* Parent or Guardian Name

* Parent / Guardian Phone

Indicate the course you intend to enroll in.

* Course

* Method Of Payment:

Please acknowledge that you have read and the following terms and conditions by entering your initials in the box below.
1	You are enrolling in an online course and is not transferable into any other course.
2	You will be required to communicate via email.
3	When you do communicate you must include your name, course, and state your question.
4	You are required to read the instructions sent that contain the information you will need to be successful in the course.
5	You have a 45 day enrollment period to complete the course.
6	A $25 will be charged for a 15 day extensions of time.
7	If you do not apply for an extension of time, your account will be disabled and remain for 30 days. After 30 days your account will be deleted.
8	You understand that should you choose not complete the course, a certificate will not be issued.
9	Refunds are not available once you login to the course.
You have read 1-9 above and agree by entering your initials here:

By signing below you agree to abide by the rules set forth in the course. Please sign by typing in your name.

* Parent Signature

* Student Signature

Submit this form once.

i virtual high