VTVLC | Create New Account

Enrollment Form

Please complete and submit the following enrollment form to apply to VTVLC.

Part-time students will be able to login and request courses once the enrollment has been submitted.

Full-time VTVLC students will not be able to request a course until the enrollment has been approved.

Please Note: A guardian account will be created for each student. It is imperative that all student data is the student's, and not the guardian's.

If you need help, please contact the office at 802-885-8331 or email [email protected]

Student Information

First Name *

Last Name *

Middle Name

School*

Student Email *

Student Phone

Race *

Hispanic *

Gender *

Date of Birth *

Grade Level *

How Did You Hear About VTVLC?

School Counselor Name *

Case Manager

Gender Identity

Enrollment Type *

Expected Year of Graduation *

Educational Plan *

What kind of device is the student using? *

Notes

Address

Mailing Address *

Mailing Address City *

State *

Country *

Dwelling Type

ZIP *

>Country of Birth

Citizenship

Physical Address (if different from mailing)

Physical Address City

Physical Address State

Country

Physical Address Zip

Is your physical address the same as your mailing address? *

Legal Parent/Guardian Information (With Whom the Student Resides)

This parent/guardian is designated as having the legal authority to make educational decisions for the student

Relationship*

Last Name *

First Name *

Phone *

Email *

Alternate Parent/Guardian Information

This person has a legal right to the students academic records and information.

Relationship

Last Name

First Name

Phone

Email

In compliance with the Children's Online Privacy Protection Act, we do not collect information FROM persons less than 13 years of age. Information must be collected FROM THE PARENTS or GUARDIANS of children under the age of 13, solely for internal use of the educational institution, and will never be disclosed to a third party.

Vermont Virtual Learning Cooperative does not discriminate on the basis of race, color, religion, national origin, gender, sexual orientation, age, gender identity, marital/civil union status or disability in admission or access to, or treatment or employment in, its programs and activities. Any person having inquiries concerning VTVLC’s compliance with the regulations implementing Title VI, Title IX, Section 504, or other state or federal non-discrimination laws or regulations is directed to contact: Ashley Newton 802-591-3015 [email protected]