ODE Enrollment Student Individual Application

LC Online Dual Enrollment Application

IMPORTANT: You will need to complete this entire application in one session. This page will not allow you to save a portion and return to complete at a later time.

If you'd rather not use this online application, we offer this PDF form .

RE-ENROLLING? Please apply here:

Returning Students
Apply Here

APPLICANT INFORMATION

Student's First Name

Middle

Last Name

Preferred Name

Date of Birth

Legal Sex MaleFemaleSelf-Identify

Primary Language Spoken at Home

Applicant Home Address

Street

City

State / Province / Territory

Postal / Zip Code

Country

Applicant's Phone Number

Applicant's Email

This email address is used for communications between the student, course coach, and the instructor.

ETHNICITY

Do you identify as Hispanic or Latino? YesNo

Student would like to be identified as one or more of the following races: American Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or Other Pacific IslanderWhite

PARENT/GUARDIAN INFORMATION (MAY BE USED FOR BILLING)

Parent/Guardian 1

First Name of Parent/Guardian 1

Middle

Last Name

Parent/Guardian 1 Address

City

State / Province / Territory

Postal / Zip Code

Country

Parent/Guardian 1 Phone Number

Parent/Guardian 1 Email

Parent/Guardian 1 is a Billing Contact? YesNo

Parent/Guardian 2

First Name of Parent/Guardian 2

Middle

Last Name

Parent/Guardian 2 Address

Street

City

State / Province / Territory

Postal / Zip Code

Country

Parent/Guardian 2 Phone Number

Parent/Guardian 2 is a Billing Contact? YesNo

Semester

*IMPORTANT: Our Computer Science courses use software that requires you to have a PC or laptop running Windows or MacOS. Chromebooks and iPads are not sufficent.

Are you applying through the Vermont Agency of Education Dual Enrollment Voucher Program? YesNo

Name, address, city, state, zip code of your most recent high school where we can obtain an official transcript

School contact name (e.g. case manager, transition specialist)

Are you applying through a high school or organization that "partners" with Landmark College?

A College partner may receive student grade reports, pay tuition, or provide students with advisors. (If you do not know if you are applying through a partnering school or organization, ask a parent, guardian, or school counselor.)

YesNoUnsure

If your High School is not a Partner with Landmark College, you must provde the completed School Authorization Form by uploading to this page.

School Authorization Form Upload

If other, please explain

PERSONAL STATEMENT - STUDENT

Please explain in your own words your goals in taking this course(s).

Please include a minimum of five sentences in your response.

STATEMENT - PARENT/GUARDIAN

Please explain the goals you have for your student taking this course.

Course Expectations for Students

Student agrees to (please check boxes and sign):

Logon to the course and course platform (Canvas) as soon as the course is open, and regularly engage in the course every week (four to five times a week), monitor their Canvas email, and communicate with the instructor and Course Coach, as needed.

Dedicate at least 9 hours per week for readings, assignments, postings, and participation in synchronous sessions and Online discussions.

Fully participate in the course from the start and immediately communicate any navigation or technical difficulties to the instructor and/or Course Coach.

Create and maintain an Online learning environment which promotes respect and integrity.

Produce high quality work that meets or exceeds course standards.

Complete all assignments, quizzes and activities by the due date; although break periods may not coincide with scheduled breaks at your high school. You are responsible to immediately communicate with the instructor or Course Coach if an assignment is not done.

Meet All Online Course System requirements (see paragraph below)

Acknowledge that this document serves as official policy for all students in the Landmark College high school Online dual enrollment program.

UNDERSTANDING OF COMMITMENT

By applying to the online Dual Enrollment program and signing this application, students indicate their understanding that this is a rigorous academic course which offers college credits upon successful completion.

NOTE: Landmark College reserves the right to waive requirements or request additional information as necessary.

Signatures below indicate that the information in this application is correct and has been clearly presented to the student; and that all participants agree with the information and commitments presented.

Student Signature

Please type your name

Parent/Guardian Signature

Please type your name