2018-19 Lakeside Learning Center Adult Education Enrollment Form

2018-19 Lakeside Learning Center Adult Enrollment

Students Over the Age of 18 whose Cohort Class has Graduated.
P.O. Box 220/2913 Ave D

Wilson, KS 67490

785-658-2460

(Fax) 785-658-2462
Date *

Month Day Year
Student Full Name *

First Name MI Last Name
Student Maiden Name

Student Address *

Street Address
P.O. Box (if applicable)
City	State / Province
Postal / Zip Code	Country

Student Phone *
Email *
example@example.com
Student Birth Date *

Month Day Year
Social Security # *
Gender *

Male Female
School District where you live: County and Number *
Alternate Contact Name: *
Alternate Contact Phone *
List ALL school(s) attended where you may have earned High School credit. Make sure you include the city, state and year(s) attended. *
Do you currently have a diploma? *

Yes No
Do You Have A GED? *

Yes No
Do You Have a Current IEP? *

Yes No
Race: Choose all that apply: *
What language do you currently speak/use most often at home? *
The Lakeside Learning Center has permission to release information pertinent to my educational success to the following people or institutions: (USD #,SRS Contact, Parent/Guardian, Relative, Recruiter…if they are not listed they are not authorized to receive information.)
Attendance Agreements
• Good attendance is the key to your success! The more work you complete the faster you will graduate!

• It takes an average of 50 hours of work to complete each ½ credit. If you work slower it will take longer. If you work quicker it will take less time. It is completely up to you!

• Lakeside Learning Center requires students over the age of 18 to complete a minimum of 1 (ONE) Full Credit to remain enrolled. Failure to complete the 1 required creidt will result in a required payment to re-enroll in the program and continue your work. 30 days of inactivity on Edgenuity will result in deactivation of your program. You will need to call in to have it reactivated and discuss a new plan of action. You will NEVER loose completed work.

All Students must create a tenative schedule. You may not follow it exactly every day but it helps to have a plan and try to stay on a schedule. The Learning Center is open Monday through Friday from 8AM to 4PM or by appointment any other time if you need to speak to a teacher or need any other assistance.

My tentative weekly online schedule will be as follows:
Sunday *
Monday *
Tuesday *
Wednesday *
Thursday *
Friday *
Saturday *
Please Read and Download for future Reference
Please Print and Return this 2017-18 Required Household Economic Survey ASAP
About the Household Economic Survey: *
My signature on this document verifies that have recieved, read and understand all of the above Statements and Agreements and the information I have provided is true and accurate as of the date of this submission.
Date *

Month Day Year
Student type full name *

First Name Last Name
Please go back over your Enrollment Application and check that ALL boxes are answered before clicking on Submit. If after clicking submit you do not recieve a "Thank You" "Your Form has been recieved" message you have left a required question unanswered, go back through and make the corrections and sumbit again. Remember it is important to download and read the Student Handboook so that you are aware of all of the requirements to be successful at LLC.
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2018-19 Lakeside Learning Center Adult Enrollment

Attendance Agreements