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	This is an ONLINE course thus, you will be required to communicate via email.
3	When you do communicate you must include your name, course name, 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 60 days your account will be deleted. No extension is offered after 60 days. You will be required to re-enroll in the course.
8	You understand that should you choose not complete the course, a certificate will not be issued.
9	If you enroll, pay tuition, do not login, and you change your mind for any reason a $25 administrative fee will be charged for withdrawal.
10	Refunds are not available once you login to the course.
You have read 1-10 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