SUMMER

INDEPENDENT LEARNING COURSES (ILC)

Application to Attend
A student attending secondary school may enrol in the Summer ILC program with written permission from
his/her day school principal/designate and has parental consent if under 18 years of age.
All course material and final examination must be completed by August 26th, 2015
* A SEPARATE FORM IS REQUIRED FOR EACH COURSE TAKEN *
PLEASE PRINT CLEARLY:
Student's Name:
Last Name

First Name

Date of Birth mm/dd/yyyy

Address:
Number

Apt No

Street

City

Postal Code

Contact Numbers:
Home

Cell

E-Mail

Day School:
Course Requested:
Course Code

New Credit

Upgrade Credit

Previous Mark

Course Location:

St. Charles Mountain Centre, 150 East 5th Street

Course Fee:

$25 Book deposit (refundable when the book is returned in good condition)

Registration, Course Material

Pick Up, Lesson Drop Off and
Marked Lesson Pick Up:
Teacher Availability:

Credit Office St. Charles Mountain

Any time from July 8 August 7, 2015
9 a.m. 3 p.m.
Wednesdays from 1:00 3:00 p.m. only throughout July and August

As a parent/guardian of the above noted student, I approve for my son/daughter to participate in the St. Charles
ILC Summer Program for Secondary students.

__________________________
Parent's Signature
(If student is under 18)

_________________
Date

________________________ ________________
Students Signature
Date

PERMISSION GRANTED BY DAY SCHOOL

I verify that this student has the pre-requisite required for the course requested above.
Principal/Designate:

Printed Name

Signature

Date