Fall 2026-2027 Part-time Course Request Form 
This form is for Lake County School students enrolled in either home education or brick-and-mortar schools who wish to take part-time courses with Lake County Virtual.

Classes start August 10, 2026. All coursework must be completed by December 18, 2026.

This form is not for credit recovery requests.

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Student First Name *
Student Last Name *
Date of Birth *
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DD
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Student Phone Number 
(Please provide the best phone number for teachers to contact you.)
 *
Student E-mail Address
(Please provide the best email for teachers to contact you.*Not your school email*)
 *
Student ID Number
Is your student currently enrolled in a Lake County school, participating in home education, or enrolled in the Family Empowerment Program? *
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