LCVS K-12 Modified Day/Part Time Student Course Request Form (2020/2021 School Year)
If at anytime you have questions while completing this form, please call the LCVS Main Office at 352-483-4260
Are you choosing these courses as part of your Modified School Day Plan? *
I (along with my parent/guardian/guidance counselor) have requested a course through Lake County Virtual School. I acknowledge that my account and access to the course will be provided by Lake County Virtual School personnel. *
First Course Requested (Please list Course name and Segment - 1 or 2 - as well as honors or regular sections) *
Additional Course(s) Requested (Please list Course names and Segments - 1 or 2 - as well as honors or regular section)
2020/2021 Course Descpritions
First Name *
Last Name *
E-mail Address *
Date of Birth *
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DD
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***Complete Username, Password, and Security Question Information Below ONLY FOR INITIAL (FIRST TIME) REGISTRATION AND CREATION OF NEW ACCOUNT (If you have existing account, skip to gender question)***
Requested User Name (WARNING: ONLY LETTERS AND NUMBERS, NO OTHER SPECIAL CHARACTERS AND NO SPACES BETWEEN LETTERS/NUMBERS)
Requested Password (WARNING: MINIMUM 8 CHARACTERS, INCLUDING AT LEAST 1 UPPERCASE LETTER, AT LEAST 1 LOWERCASE LETTER, AND AT LEAST 1 NUMBER; NO SPACES )
Security Question 1
Security 1 Question Answer
Security Question 2
Security 2 Question Answer
Gender *
Grade *
Physical School *
Other School (If chosen above)
School Counselor Name *
Street Address *
City *
Zip Code *
Phone Number *
Parent/Guardian LAST Name *
Parent/Guardian FIRST Name *
Parent/Guardian Email Address *
Parent/Guardian Phone Number *
***Please wait for email verification before attempting to enter Virtual School website for course access. Thank you for choosing LCVS!***
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