Lake County Virtual School Course Request Form (2019-2020 School Year)
If at anytime you have questions while completing this form, please call the LCVS Main Office at 352-483-4260
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) *
Your answer
Additional Course(s) Requested (Please list Course names and Segments - 1 or 2 - as well as honors or regular section)
Your answer
2018-2019 Course Descpritions
First Name *
Your answer
Last Name *
Your answer
E-mail Address *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
***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)
Your answer
Requested Password (WARNING: MINIMUM 8 CHARACTERS, INCLUDING AT LEAST 1 UPPERCASE LETTER, AT LEAST 1 LOWERCASE LETTER, AND AT LEAST 1 NUMBER; NO SPACES )
Your answer
Security Question 1
Security 1 Question Answer
Your answer
Security Question 2
Security 2 Question Answer
Your answer
Gender *
Grade *
Physical School *
Other School (If chosen above)
Your answer
School Counselor Name *
Your answer
Street Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Phone Number *
Your answer
Parent/Guardian LAST Name *
Your answer
Parent/Guardian FIRST Name *
Your answer
Parent/Guardian Email Address *
Your answer
Parent/Guardian Phone Number *
Your answer
***Please wait for email verification before attempting to enter Virtual School website for course access. Thank you for choosing LCVS!***
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