8/7/2019 Application Form for Online Coursework 4-3-11 PDF

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Student Name: ________________________________ Year of Graduation: _________ Today’s Date: ________  

Home Phone: __________________ Cell Phone: _________________ Student E-mail: _____________________ 

Online Course Name: _______________________________________ Provider: __________________________ 

Online courses may be taken during the school day or as an independent study outside of the school day. Please

indicate your plan. (circle) at school  or  independent study 

In what term do you plan to take this course? (circle) 1st Semester …..2nd Semester ....J-term…..Summer Semester  

What is the reason for taking this course online? ____________________________________________________ 

____________________________________________________________________________________________ 

Office Use Only

Administrative Approval Signature: __________________________________________ Date: _______________ 

Course Name: ____________________________________ Provider: _____________________ Cost: ________ 

Academic Achievement Review: _______ Conduct Review: _______ Attendance Review: _______ Payment received: _______ 

Passed All Sections of OGT: _____ Credit attempted for: _______ Remediation _______ Replacement _______ Elective

9391 Washington Church Rd.

Miamisburg, OH 45342

(937) 291-7285

1101 John Wesley Ave.

Xenia, OH 45385

(937) 352-1640

Statement of Understanding

We understand that online coursework requires a high level of self-discipline and motivation by a stu-

dent. Academic intervention and support is not as readily available as it is with the traditional class-

room setting.

We understand that these online courses are accomplished in conjunction with 3rd party organizations

and may include slight differences in course objectives and integration from traditional Dayton Chris-

tian courses. We understand that online courses require additional tuition payments by the family/student to the 3rd

party providers beyond the regular tuition payments to Dayton Christian Schools. Payment for any

Sevenstar course is to be included with this application and made payable to “Dayton Christian

Schools.”

In order for a student to receive credit from Dayton Christian Schools for any online course, adminis-

trative approval must be granted in writing before a student registers for the course.

The signatures below indicate an understanding and agreement with this framework for online course

enrollment.

Parent Signatures: _____________________________________ ____________________________________ 

Parent E-mail: ______________________________________________________________________________ 

Student Signature: ___________________________________________________________________________ 

8/7/2019 Application Form for Online Coursework 4-3-11 PDF

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9391 Washington Church Rd.

Miamisburg, OH 45342

(937) 291-7285

1101 John Wesley Ave.

Xenia, OH 45385

(937) 352-1640

Pricing for the 2011-2012 school year:

Traditional High School Courses…….………Year long: $490.00……...…....Semester: $390.00 

AP Courses………………………………….……………..…..………………………….$590.00 

Dual Credit Courses through Indiana Wesleyan and Taylor Universities…………….….$590.00 

Payment for these courses should be made to Dayton Christian Schools and submitted with theonline course application to the high school office.

Some courses require an additional purchase of a textbook and lab fees. See course catalogue.

Cedarville University Dual Credit Courses……………………..………………………..$450.00 

Payment for these courses should be made directly to Cedarville University in accordance

with their registration policies after the online course application has been approved by the high school office.

This does not include textbook costs.

Total Cost

Course Name: ______________________________________________________ Cost: ______________ 

Annual...One Time...Non-refundable registration fee for any on-line course.……………….………………$15.00 

TOTAL ______________ 

Please make checks payable to Dayton Christian Schools.