Registration for 10 - 12

* - Required field

I am enrolled in a school other than NIDES.
	Name of school:
		I understand that my current school administrator will be notified of my course selection.
I am not enrolled in another school.
	Name of last school attended:
	Location of last school attended:	(Enter "none" if you were not at another school)
	Date last attended:

The Applicant confirms that the information in this form is accurate and complete, that the Applicant has the legal right to enroll the student in NIDES, and that the Applicant understands that no materials will be forwarded until fees and deposits (where applicable) are paid; that work required will be completed and returned as directed; and that enrollment remains valid for one year.	I agree
The Applicant confirms the legal guardian, student, and home facilitator’s commitments to working together with NIDES 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 the NIDES teachers (weekly).	I agree
The Applicant understands that if the student is inactive, he/she may be withdrawn from the course.	I agree
The Applicant understands that for some secondary courses, there are unit tests and exams that will require a test center. If the applicant attends a secondary school, this is the location where he/she will write tests. If not, NIDES has test centers established on north Vancouver Island. Students outside this region will be responsible for any costs associated with test supervision.	I agree
If using NIDES computers and/or online services, the Applicant agrees that the Internet access only be for educational and lawful purposes.	I agree
The Applicant hereby authorizes the release of all previous records to the North Island Distance Education School, and authorizes North Island Distance Education School to report to schools, school districts, or post-secondary institutions where records exist.	I agree
I declare that I am ordinarily resident in British Columbia and if I am traveling outside of the province of BC, I will inform the registrar (registrar@nides.bc.ca) in writing of my intended return date to British Columbia.	I agree
By completing this form and submitting it, it is assumed that the Applicant agrees to the above conditions of enrollment.	I agree

Questions/Comments:

A. Student Information
*Legal Surname		Usual Surname
*Previous Surname(s) (Enter "none" if student does not have a previous surname)
*Legal FIRST Name		Usual First Name
*Legal MIDDLE Name	(Enter "none" if student does not have a middle name)	*Gender	Male Female
*Legal MIDDLE Name	(Enter "none" if student does not have a middle name)	*Date of Birth
*Telephone - Home		Fax
Telephone - Work		*Student's Email	(Enter "none" if student does not have email)
*Resident of British Columbia?	Yes No	*Parent/Guardian Email	(Enter "none" if parent/guardian does not have email)
NIDES can accept these students, who currently reside in British Columbia. (Those traveling temporarily outside of BC are eligible.) BC residents are tuition free. International students in BC will pay appropriate tuition.
*Select the student citizenship status:	Canadian Citizen Landed Immigrant International Student in a BC School (Name of school: )
NOTE: Please make sure to include any PO boxes, suite #’s etc... or any information we will need to ship you materials.
*Home Address		Mailing Address (if different)
*City		City
*Province		Province
*Country		Country
*Postal Code		Postal Code
*First & Last name of Parent/Guardian	(Enter NA if not applicable)	*Relationship	(Enter NA if not applicable)
		Address & Phone if different from student's
First & Last name of Parent/Guardian		Relationship
		Address & Phone if different from student's
*First Nations, Metis, Inuit Aboriginal Ancestry?	None Status - On Reserve Status - Off Reserve Non Status Metis Inuit
B. Education
*Has student received Learning Assistance?	Yes No	Learning Assistance areas of focus:
*Has student had an Individual Education Plan?	Yes No I Don't Know	If there was an IEP, when was it done? (YYYY-MM-DD)
If your child is new to NIDES, and you have answered yes to any of the above questions, complete and submit this signed release by fax, mail or drop off to NIDES.
*Grade you last completed:	None K 1 2 3 4 5 6 7 8 9 10 11 12 Graduated
*Are you currently taking a course at NIDES?	Yes No