SCIDES Registration

South Central Interior Distance Education School PO Box 4700 Stn Main Merritt, B.C. Canada V1K1B8 Ph:1.800.663.3536 Fax: 250.378.1447 Application Form (Grades 8 - 12, Adult) * denotes a required field
A. Student Information
Legal Last name *	Legal First name *	Legal Middle name	Gender *
Usual Last name *	Usual First name *	Birthdate (mm/dd/yyyy) *
Parent(s)/Legal Guardians are Permanent of ResidentsBC: * YES NO ADULT LEARNER
Previous Last Name If Applicable	Telephone Number (Home) *	Telephone Number (Cell)	Telephone Number (Work)
Student Email Address	Student PEN	First Nations, Metis, Inuit, Aboriginal Ancestry? * YES NO DECLINE RESPONSE Band Name
Mailing Address * City * Province * Postal Code *		Physical Street Address (If Different) City Province Postal Code
First and Last Name of Mother/Guardian (Include Relationship) *		Address and Telephone No. (If Different From Student)
First and Last Name of Father/Guardian (Include Relationship) *		Address and Telephone No. (If Different From Student)
Parental Email Address (For School/Home Communication Purposes Only)
Does your child have special learning needs? YES (* ATTACH DOCUMENTS IF POSSIBLE)		Does your child have any medical issues that affect his/her learning? Check for Yes
Are you currently enrolled / attending a High School? * YES NO Name of Current High School or Last School Attended*		Current High School Address or Address of Last Attended	Current High School Phone or Phone of Last School Attended
Last school grade completed * The year last grade was completed *
My grade as of september is: * Gr 8 Gr 9 Gr 10 Gr 11 Gr 12 Graduated Adult (19+) Unknown
B. Payment Information
DEPOSIT (out of country = full value of resources) School Age Students: $100.00 total (to a maximum of $300.00/family) Over age 19 or Graduated Student: $100.00/course		Total Deposit $	I will contact SCIDES to formalize payment options. (Try to get resources from your school so that NO deposit is required) *
Grades K-9 students enrolled in another school only: TUITION Print / Online / Online Supported: $600.00/course
Current School Name: Phone/Fax:	To invoice for tuition and requested texts Name Title Email Address Authorization letter to bill to follow
Deposits will be refunded only when there has been activity in the course and all textbooks are returned in good condition. Textbooks must be returned within eight weeks of course completion or withdrawal from the course(s) or an invoice for the full replacement value will be issued for any textbooks not returned, minus any deposit on file.
C. SCIDES Student Learning Plan
a) Note anything that may affect your school work (job, family responsibility, illness, travel, sports, etc.) *
b) Who will support you in your learning at home? *
c) Long-term goals: Plans for after high school (post-secondary plans/future career choices) *
d) List Interests, Hobbies, Extra-curricular Courses: *
* I certify that the courses I have requested below in Section D, either fit my current Student Learning Plan or, have been verified by my counsellor. Name:
The Applicant confirms the legal guardian, student, and home facilitator's commitment to working together with SCIDES in completing the coursework agreed to by all parties during the normal academic calendar (unless otherwise negotiated). Working together is defined by consistent activity in courses (unless previously agreed to, consistent activity is defined as weekly submissions according to the personal education plan of the student) and continuous communication with SCIDES teachers. * APPLICANT INITIALS PARENT/GUARDIAN INITIALS (if under 19 years of age)
D. Course Information
www.scides.ca or phone for course offerings as well as delivery options.
Courses / Programs Requested @ Scides *	Courses Planned or Underway at Other School(s) or DL Program(s) (if applicable)		Publicity Waiver I hereby permit the school to disclose my name, phone number, mailing address, and my child's name to the Parent Advisory Council for the purpose of school related communications. I hereby permit my name or my child's name or photos to be used in any school publication including a monthly newsletter, or web pages as well as newspaper recognition of achievements.
By signing this form, the applicant/parent-guardian agrees that materials on loan will be kept in good condition and returned promptly when the applicant completes or discontinues the course(s). If the materials are not returned in good condition, then the applicant agrees to pay the replacement cost and/or will forfeit the deposit. My signature also authorizes SCIDES to report to schools, school districts or post-secondary institutions, and upon moving to another region, to transfer the file to the appropriate school.
* As a student, I agree to the commitment above, and to provide all required documentation below		* As a parent/guardian, I agree to the commitment above, and to provide all required documentation below
Required Documentation: 1) A copy of one of the following: Care Card, BC Driver's Licence, BC ID Card. If you are unable to provide one of these, then download this disclaimer and submit/attach this "Student Declaration" 2) All applications require a copy of a Transcript / Permanent Student Record (Gr. 10 -12 / Graduates) or Report Card (Gr. 8 - 9) If you are able to scan and attach your docmentation, use the upload box below: Select A File To Upload: note: only .pdf, .jpg, .gif and .bmp file formats are accepted. maximum file size is 2MB

South Central Interior Distance Education School

Application Form (Grades 8 - 12, Adult)