Distance Learning Course Request Form
Submit your request for a distance learning course. Please complete all sections carefully.
Student Name
*
First Name
Last Name
Student’s Base School
*
Current Grade
*
Online Course Requested
*
Time Frame for Course
*
Full Year
Semester 1
Semester 2
Quarter 1
Quarter 2
Quarter 3
Quarter 4
Other
Other (Please list)
Course Provider
*
Saskatchewan Distance Learning Centre
Other Approved Provider
Other Provider Please List
Reason(s) for Request of Distance Learning Course
*
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Signature
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Office Use Only
Prerequisites in Place
Yes
No
Request fits into timetable
Yes
No
Time of Course (Period/Day)
Assigned Room Location
Course Supervisor
Print
Submit Request
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