Kindergarten - Grade 7
Ministry of Education, BC
School District #8 (Kootenay Lake)
This form should be completed on both sides
Please type or print clearly
811 Stanley Street
Nelson, BC V1L 1N8 / Phone: 250. 354.4311
1.800.663.4614
Fax: 250. 505.7007
A. Student Information / (Please Complete as Applicable)
Legal Surname: / Legal First Name: / Legal Middle Name(s):
Usual Surname: / Male
Female / Usual First Name: / Usual Middle Name(s):
If Surname Changed Give Previous Name / Hm Ph: ()
Wrk Ph: () / Birthdate:
DD MM YY
Mailing Address: / Have you previously enrolled in Distance Education?
YES NO
City: / Distance Education Student Number:
Province: Postal Code: / Personal Education Number / School Dist. Name & No.
E-Mail Address: / Province of Birth:
Country of Birth:
First & Last name of Mother/Guardian: Address & Phone No. (If different from student)
First & Last name of Father/Guardian: (if different from above)
B. Program and Course Information
Primary Year: Intermediate Year: / In-School Program:
**Kindergarten / Grade 4
Grade 1 / Grade 5
Grade 2 / Grade 6
Grade 3 / Grade 7
**Kindergarten registration requires a copy of the student’s Birth Certificate
Additional Information:
C. Do you own a computer? Yes No If yes, what type:
Operating system: (Windows XP, Mac OS X, etc):
D. To be completed by students who will be living outside B.C.
B.C. Shipping Address:
Turn for page 2
E. All applicants who are NOT attending school (please attach school report card)Name of last school attended (and address if known) / Last school grade completed
Grade / Year last grade completed
19
If withdrawn from school during year, state grade, month and year:
I left Grade in 19
Are school records enclosed?
Yes No / Applicant is out of school because of:
Employment Personal Choice
Illness Distance
Travelling within B.C. Travelling out of B.C.
F. All Applicants
If you are of school age, are your parents / legal guardians, residents of B.C.? Yes No
Primary language spoken in the home: English French Other (Specify)
Are you of First Nations Ancestry? Yes No Status Band Non Status
G. Payment
Please indicate how you came to hear about DESK: / Amount Owing:
Textbook Deposit $
Computer Deposit $
TOTAL $
VISA #:
VISA Expiry :
The signing of this form indicates that the information is accurate and complete and that the Applicant understands that no materials will be forwarded until deposits (where applicable) are paid; that only part of a course is sent out at a time; that course papers are forwarded on the understanding that work required will be completed returned as directed; and that enrollment remains valid for a maximum of 2 years.
By signing this form, the Applicant agrees that textbooks (when student is eligible to receive them on loan) and/or videos and/or computer diskettes will be kept in good condition and returned when the applicant completes or discontinues the course(s). If the materials are not returned in good condition, then the Applicant will forthwith pay the replacement cost thereof or will forfeit the deposit.
I hereby authorize DESK to report to schools, school districts, or post-secondary institutions, and upon moving to another region, to transfer the file to the appropriate Distance Education School.
Cardholder Name:
If applicable, appropriate payment MUST accompany application form.
Please make cheque or money order payable to:
Distance Education School of the Kootenays
811 Stanley Street
Nelson, BC
V1L 1N8
May we have your permission to include your child’s work on our website @sd8.bc.ca/DESK Yes No
Date of application: / Distance Education Teacher:
Signature of parent or guardian:
Browse through the Guidebook on the Internet: http://www.openschool.bc.ca/de/
Nov 04 vp