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Course Application Form
STUDENT REGISTRATION AND ENROLLMENT
Please contact us at (250) 635-7944 if you have any trouble and we will gladly help you with the on-line registration process

= required fields

Unless otherwise instructed, leave fields which do not apply to you as blank instead of filling with N/A or similar.

Anywhere you see the Help available icon, you can place your mouse pointer over it and get further instructions.

Anywhere you see the Warning icon, you can place your mouse pointer over it and get information about a possible error in your application.

Full Name:Help
Usual Surname
First Name
Middle Name(N/A if none)
Other Names:Help
Legal Surname
Maiden Name
Other Name
Agreements:Help
I agree to provide a fully refundable deposit of $100, if textbooks are required.
I have read and agree to the school code of conduct:http://www.ncdes.ca/includes/Code of Conduct.pdf
I declare that I am a resident of British Columbia.
I declare that I am not enrolled in another school or that my School of Record:Holds my complete Permanent Student Record including proof of birth and proof of residence.Will update that Permanent Student Record upon receipt of a final mark from North Coast Distance Education School.Is responsible for my graduation plan, of which the courses on this application form a part.Verifies that I am NOT currently taking this course at my school of record.
I understand the following:The school board is responsible for the educational program of the student.The school board is responsible for ensuring that student learning is directed by a member of the College of Teachers.The school board is responsible for assessment and reporting on the student.The Student Learning Plan will meet the Ministerial Orders for the Required Areas of Study and the Graduation Requirements.I am committed to attending meetings and submitting assignments and materials as required by the teacher for assessment and reporting purposes.I am committed to my education program through distributed learning with NCDES and will complete all courses listed on my current Student Learning Plan.I have read and agree to the conditions of the Code of Conduct and Acceptable Use Agreement for Internet Access.
I understand and agree that my progress will be shared with the contacts I will supply below.
I agree that NCDES will use my email account even if it may transmit personal and confidential information to me through services outside of Canadian jurisdiction.

Student Information

Birthdate:
Designation:
Gender:
 
Phone:
Home eg. 250-222-2500
OtherHelp
 
Email:
Email Address:
Confirm Email Address:
 
Mailing Address:
Street
City
Postal code(V1V 2L3)
 
House Address (if different from above address):Help
Street
City
 
 
 
Contacts (school, parent, guardian): Help
Contact 1:
Email:Help
Name:
Phone:
Relationship:Help
Contact 2:
Email:Help
Name:
Phone:
Relationship:Help
 
Special Needs:Help
 
Medical Alerts (allergies,conditions):Help
 
Aboriginal Status (if applicable)
Aboriginal Ancestry
If Yes
What Band do you belong to?
What Reserve do you live on?
 
Current School Information:
What school are you currently enrolled in? Help
provincial education numberHelp
Name of Counsellor or AdministratorHelp
Current Grade:Help
 
Course Selection:Help
Please select from the following courses which meet requirements for Adult Dogwood High School Diploma. The Adult Dogwood requires a Mathematics 11, and four Grade 12 courses including English or Communications. Social Studies 11 counts as a Grade 12 course. If you have other courses in mind please add these courses once your program is underway.
Select From this List:Selected Courses:
 
Target starting date
Target ending date
I agree to the student work and likeness release form as detailed at http://ncdes.ca/includes/release.pdf
 
 

Thank you for your registration. Upon successful completion, you will get an email shortly confirming your request. If you have not received this email in 15 minutes, please check your junk mail folder and if it is not there then contact NCDES to resolve the issue. Be sure to submit your first assignment as soon as possible to activate your registration.