Kirkwood Community College - Continuing Education

HSDL Registration Form

Important Notice:

This registration page will be under construction from June 29 to July 6 to update FY21 class information. During this time, the form will not be available to accept registations. Please plan accordingly.

The start date for a class begins immediately following registration. Please register your student when they are ready to begin the class.

Student Demographic Information

Last Name	First Name	Middle Initial
Street Address	City	State
Zip Code	Date of Birth	Kirkwood K#
Primary Phone Number	Primary Email Address	Gender
Parent Phone	Parent Email
School District Information for Billing
Name of School District	Phone Number	Fax Number
Address	City	State
Zip Code	CEEB Code (ACT Number)
School Information for Curriculum Delivery
Name of School	Address	City
State	Zip Code
1. Contact Name (Proctor)	Email Address	Phone Number
Send Final Grade	Send Written Tests
2. Contact Name (Proctor)	Email Address	Phone Number
Send Final Grade	Send Written Tests
Course Information - Use dropdown menu Course 1: Course 2: Course catalog link: https://www.apexlearning.com/digital-curriculum/courses/catalog Not all classes in this link are currently offered. SCED Finder link: https://nces.ed.gov/scedfinder/Home/Browse Kirkwood HSDL can no longer accept payments directly from students or parents. All courses will be billed direclty to the school district. It is recommended that students sign up for no more than two (2) courses at a time. For local schools, you should list the person to receive final grades and notifications of difficulties that a student may be having in online/correspondence courses. For schools at a distance, you should list the person(s) that you would like to receive weekly notifications of progress in online courses and the person that will be emailed the written tests. Terms and Conditions for School District* By signing this registration form, the school district accepts responsibility for payment of all fees related to the course, responsibility for granting student credit upon completion of the course (Kirkwood HSDL will send a recommended grade to the proctor), providing or approving an acceptable proctor, and monitoring student progress during their four (4) months to complete the course. Students needing accommodations should submit paperwork to the HSDL office prior to starting courses. School Official Signature and date: Terms and Conditions for Student By checking this box, I understand that I need to have a valid email address and complete at least one assignment weekly. I authorize Kirkwood Community College to provide information to the school and to the email addresses provided regarding enrolment status, grades and credit. I acknowledge that I have four (4) calendar months from the date of enrollment to complete the course, and if not finished in that time, I agree to take an incomplete in the course. I understand that these courses are for High School credit only. Student Signature on File Parent Signature on File (if student is not 18) If your student has an IEP/504 for which they would like accommodations (modifications are not allowed), contact our High School Distance Learning Staff at HSDL@kirkwood.edu.