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
* Required
Are you choosing these courses as part of your Modified School Day Plan?
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Yes
No
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.
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I acknowledge the statement above.
First Course Requested (Please list Course name and Segment - 1 or 2 - as well as honors or regular sections)
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Your answer
Additional Course(s) Requested (Please list Course names and Segments - 1 or 2 - as well as honors or regular section)
Your answer
2020/2021 Course Descpritions
For a full list of course descriptions, please visit:
https://docs.google.com/document/d/1iWbjB8ErtHi8YPHBdc_o9TYnPrfPIAWWPXBWw4ch9m0/edit?usp=sharing
First Name
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Your answer
Last Name
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Your answer
E-mail Address
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Your answer
Date of Birth
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MM
/
DD
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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
Choose
In what city did your mother and father meet?
In what city was your father born?
In what year was your mother born?
What company did you work for at your first job?
What is the first band/artist you saw in concert?
What is the name of the hospital where you were born?
What is the name of the street your first home was on?
What is your oldest cousin's first and last?
What was the mascot of your first school?
What was your first pet's name?
What was your kindergarten teacher's last name?
Where did you go the first time you flew on a plane?
Security 1 Question Answer
Your answer
Security Question 2
Choose
In what city did your mother and father meet?
In what city was your father born?
In what year was your mother born?
What company did you work for at your first job?
What is the first band/artist you saw in concert?
What is the name of the hospital where you were born?
What is the name of the street your first home was on?
What is your oldest cousin's first and last?
What was the mascot of your first school?
What was your first pet's name?
What was your kindergarten teacher's last name?
Where did you go the first time you flew on a plane?
Security 2 Question Answer
Your answer
Gender
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Female
Male
Grade
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Choose
K
1
2
3
4
5
06
07
08
09
10
11
12
Physical School
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Choose
Carver Middle School
Cecil Gray Middle School
Clermont Middle School
East Ridge Middle School
East Ridge High School
Eustis Middle School
Eustis High School
Lake Minneola High School
Leesburg High School
Mount Dora Middle School
Mount Dora High School
Oak Park Middle School
Tavares Middle School
Tavares High School
Umatilla Middle School
Umatilla High School
Windy Hill Middle School
South Lake High School
Astatula Elementary
Beverly Shores Elementary
Clermont Elementary
Cypress Ridge Elementary
Eustis Elementary
Eustis Heights Elementary
Fruitland Park Elementary
Grassy Lake Elementary
Groveland Elementary
Leesburg Elementary
Lost Lake Elementary
Pine Ridge Elementary
Rimes Early Learning Center
Sawgrass Bay Elementary
Seminole Springs Elementary
Sorrento Elementary
Tavares Elementary
Treadway Elementary
Triangle Elementary
Umatilla Elementary
Villages Elementary of Lady Lake
Other School (Please Type Below)
Other School (If chosen above)
Your answer
School Counselor Name
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Your answer
Street Address
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Your answer
City
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Your answer
Zip Code
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Your answer
Phone Number
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Your answer
Parent/Guardian LAST Name
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Your answer
Parent/Guardian FIRST Name
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Your answer
Parent/Guardian Email Address
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Your answer
Parent/Guardian Phone Number
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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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