Vanguard Manual Course Enrollment Form

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MANUAL COURSE ENROLLMENT FORM
From our Home Page or our literature, please choose the type of course format you would like, select a subject
area, choose the course(s) you would wish to enroll, and complete & mail this form to manually enroll for courses.
THE FOLLOWING SECTIONS MUST BE COMPLETED FOR MANUAL ENROLLMENT.
PERSONAL INFORMATION & LOG-IN INFORMATION
SSN*
______________-__________-______________
BIRTH DATE* ______/_______/__________
(Please see Privacy Policy for additional information.)
NAME* ______________________________________________________________________________________
Title
/
First Name
/
Middle Name
/
Last Name
ADDRESS* ____________________________________________________________________________________
Street
/ Apt. or Unit # /
City
/ State /
Zip
PHONE(s)* ___________________________________________________________________________________
Home Phone #
/
Cel Phone #
/
Other Phone #
EMAIL* ___________________________________________________@__________________________________
ALT EMAIL ________________________________________________@__________________________________
PASSWORD* _________________________________________________________________________________
(Please provide your Site Password, or create a Password here in order for us to manually enter you into our site.)
SCHOOL DISTRICT* ______________________________________ (Please email or call us if you are in the LAUSD)
PREVIOUS VANGUARD STUDENT:
YES
NO
PLEASE CHECK IF ANY OF THE ABOVE INFO HAS CHANGED
/
COURSE INFORMATION – for MANUAL ENROLLMENT
CLASS NUMBER: ________________ CLASS TITLE:____________________________________________________
PROVIDER:
FACE-TO-FACE
PDE
ASCD
ANNENBERG
OTHER ___________
COURSE CREDIT: _________ LOCATION & DATE: ____________________________________________________
(If Applicable)
COST PER UNIT
Regular Enrollment Fee: $ 276.00
Late Enrollment Fee:
$ 10.00 (Currently Waived)
(Late Enrollment fee applies if payment clears after the first FACE-TO-FACE class has begun)
Manual Enrollment Fee:
+ $20.00
(Coordinator Code: _______________)
TOTAL FEE ENCLOSED:
$ 296.00
PLEASE FILL OUT ANOTHER FORM FOR EACH ADDITIONAL COURSE.
CCC Manual Enrollment Form - Page 1 of 3

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