Enrollment Form For US Students Enrollment - US Students Step 1 of 6 - Enrollment Agreement 0% Instructions for Completing Enrollment Forms Liberty High School is committed to the highest standards in distance education. All of our class assignments and testing are completed in the privacy of your home and supported by qualified high school instructors who are available by phone and email. In order for us to serve you and your educational needs, please fill out these forms carefully, there are 6 sections to complete. Indicating that you agree with each section acts as your electronic signature when enrolling online. If paying online, program option and method of payment will be chosen at checkout. You can pay tuition by choosing from several payment options on our Easy Pay page. Enrollment Agreement - Read carefully, fill out completely, indicate that you agree to abide by each section of the enrollment agreement. Terms and Conditions - Read carefully, indicating you agree with this section acts as your electronic signature. Transcript Authorization - It is very important that you are accurate in filling out the information requested on the Release of Information Authorization. Otherwise, the registration process may be delayed. Please be sure to agree to this authorization which acts as your electronic signature. If you attended more than one high school, add those school names where indicated. You're agreeing that this is equivalent to creating a Release of Information Authorization form for each school. Disclaimer - Understanding other admissions policies. Honor Code - Stating all work will be done by the student who signed enrollment agreement. Diploma Name Form - This form is to ensure that your Diploma will be printed as you wish your name to appear on this official document once you complete the program successfully. If you have any questions or need assistance completing the forms, please call the Liberty High School Admissions Office at 1-800-594-5550 By Mail Liberty High School 20 Technology Dr. Brattleboro, VT 05301 ATTN: Registrar By FAX (802) 246-1406 For Credit Card payments not completed online.Student's Name* First Middle Last Suffix Street Address*City*State*Zip Code*Phone*Email* Date of Birth* MM slash DD slash YYYY The above listed school and student enter into agreement under which the student will pay tuition and fees as indicated below as well as adhere to the school’s rules and regulations pertaining to course completion as set forth in the school catalog. The school will instruct in the curriculum listed in accordance with the regulations of the Vermont State Board of Education. Senior Year Option Basic Program Option Extended Program Option Tuition = $995(Minimum of 5 Courses)Down Payment of $300 ($895 with full pay) Tuition = $1,295(6 to 10 Courses)Down Payment of $300 ($1,165 with full pay) Tuition = $1,495(11 to 20 Courses)Down Payment of $300 ($1,345 with full pay) Interest-Free Payment Plans Available | Pay Your Tuition on our Easy Pay page after submitting all 6 sections of your Enrollment Forms Students must complete 20 academic units successfully to receive a High School Diploma from Liberty High School. The 20 units will be a combined total of units earned from both your previous high school experience and the courses you complete successfully at Liberty High School. 4 English (9, 10, 11, 12) 3 Science (Biology + 2 additional course) 3 Math 3 History (U.S. History + 2 additional course) 7 Electives (general academic, language, health/nutrition, reading, study skills, computer) Physical Education If you have previously attended high school, check the highest grade completed: 9th grade 10th grade 11th grade 12th grade Received passing grades in all subjects? Yes No Last year attended:Name of SchoolAddress of School Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Check off the subjects you took and passed previously in high school:English 1st yr. English 2st yr. English 3rd yr. English 4th yr. English Reading Short Story Writing Grammer & Writing Science General Science Physical Science Biology Chemistry Physics Health Math General Math Business Math Pre-Algebra 1st yr. Algebra 2nd yr. Algebra Geometry Fundamental Math #1 Fundamental Math #2 Fundamental Math #3 Social Studies U.S. History World History Social Civics (Government) Geography Economics Political Science Behavioral Science Other Study Skills Computer Basics Communications Critical Thinking Drawing Physical Education Foreign Language We understand that you may not remember everything you took in high school. Our staff will use the information you have completed above to set up your initial program. Finalization of your program and tuition investment will be made when we have received an official transcript from your previous high school(s).Transcript Agreement* I understand that finalization of my program and tuition will be made after receipt of official transcript from my previous high school(s). Tuition Agreement* The above listed school and student enter into agreement under which the student will pay tuition and fees as indicated above as well as adhere to the school’s rules and regulations pertaining to course completion as set forth in the school catalog. The school will instruct in the curriculum listed in accordance with the regulations of the Vermont State Board of Education. Terms and Conditions Liberty High School agrees to provide the student named in this agreement with a high school education by the use of textbooks similar to those used by other high schools approved by the Vermont State Board of Education, supplemented by study guides especially developed for home study use. The tuition covers registration, instruction, all text materials, consulting privileges, and postage on all material sent to the student. The minimum number of credits to be taken to obtain a Liberty High School diploma is five. The final tuition of the high school diploma program depends on the number of credits that can be transferred and verified by official transcripts from the high school(s) the student attended previously. Liberty High School agrees to make an allowance for previous high school training except for Physical Education, Driver’s Training, Religion, Chorus, Band or R.O.T.C. If an official transcript or other excepted documents is not available, the student must take 20 credits in order to earn a high school diploma from Liberty High School. Lessons will be sent to the student in a manner so that they should be available in advance of the student’s rate of progress. Should the student need lessons at a faster pace, they will notify Liberty High School in writing, explaining the reasons required for more rapid service. All such requests will be reviewed by the Student Service Department as long as students payments are up to date. Additional shipping fees may apply. Liberty High School agrees to allow the student two years to complete this course if necessary. During that period, Liberty will render to the student such services that the student may request in the form of supplementary instruction and guidance. Upon successful completion of all academic and financial requirements, a diploma from Liberty High School will be awarded to the student. Liberty High School cannot guarantee acceptance into college, training programs, or the armed services of the United States. Policies very from school to school, Military acceptance hinges on a variety of factors.I have read and understand the above terms and conditions.* I agree to the above terms and conditions. Refund Policy Liberty High School will refund your tuition according to the following refund policy. You may request cancellation in any manner, but written request is recommended. You may notify the school of your intent to cancel by mail, addressed to Liberty High School, 20 Technology dr. #5, Brattleboro, VT 05301 If enrollment cancellation is requested within five (5) days of signing the enrollment agreement, the school will issue a refund in full. If enrollment cancellation is requested after five (5) days of signing the enrollment agreement, and before the school receives the first lesson assignment submitted for grading, Liberty is entitled to a registration fee of 20% of the total tuition or $200.00, whichever is less. If the school is notified of cancellation after five (5) days of signing the enrollment agreement, and after one or more lesson assignments have been submitted to the school for grading, Liberty shall be entitled to a registration fee of 20% of the total tuition or $200.00, whichever is less, and to a charge which shall not exceed the following: (a) Up to and including completion of the first 10% of the program, the student will be obligated to Liberty for 10% of the tuition minus the amount of the registration fee. (b) When cancelled after completion of more than 10% and up to and including 25% of the program, the student will be obligated to Liberty for 25% of the tuition minus the amount of the registration fee. (c) When cancelled after completion of more than 25% and up to and including 50% of the program, the student will be obligated to Liberty for 50% of the tuition minus the amount of the registration fee. (d) When cancelled after completion of more than 50% of the program, the student will be obligated to Liberty for the full tuition cost of the program. A student enrolled in the high school diploma program has two (2) years from the original date of acceptance to complete his or her program. This contract will cease to be in effect after two years from the original date of acceptance. No requests for refunds will be considered thereafter. This enrollment cancellation policy is based upon the total tuition cost of the program. The percent of the program completed shall be the coursework received by the student as compared to the total coursework to be sent by Liberty High School. I agree to the conditions of this entire agreement, I also verify that I have read and understand this agreement.* I agree to the entire above agreement. A copy of this Enrollment Agreement can be downloaded from our Enroll Now page or you may download it now. Release of Information AuthorizationI,hereby authorize (Your previous school)(Your 2nd previous school if applicable)(Your 3rd previous school if applicable)to release to Liberty High School my high school transcript. This information is being requested to establish credit for previous academic achievement toward programs offered by Liberty High School. This release of information will remain in effect during my participation in the educational programs of Liberty High School. The transfer and use of this information will be done in a manner that adheres to all codes and procedures governing confidential records and their transfer from one agency to another.Name while attending this school: First Middle Last Suffix Date of Birth MM slash DD slash YYYY Current Street Address of this School Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Signature for Release of Information Authorization I agree to authorize the release of information as stipulated above. DisclaimerWe have been successful in getting our students into colleges, training programs and armed services. (Please check to see our list of successful graduates) However, colleges and/or employers establish their own admissions policies. These policies vary from school to school. Military acceptance hinges on a variety of factors from region to region, even day to day.I,understand that you (Liberty High School) cannot guarantee acceptance into a college, training program or the armed services of the United States. NO SCHOOL can guarantee acceptance. Signature for Disclaimer* I have read and understand the above disclaimer. Honor CodeAs an approved school by the Vermont State Board of Education, all of our students are required to sign an honor code form stating that the work will be done by the student who has signed up for the diploma program. We recognize that a student may seek help and so encourage that student to consult our tutors, as well as solicit opinions from others. This is a normal and acceptable practice. However, the tests and workbook materials sent in must be the work of the student whose signature is below.I,attest that the work I submit to Liberty High School will be my own.Signature to Accept Honor Code* I have read, understand and agree to abide by the above honor code. Diploma Name FormName as you would like it to appear on your diploma.* First Middle Last Suffix If you have not already paid your tuition down payment or paid in full please visit our Easy Pay page. Once the enrollment form and down payment is received your application will be activated. If you have questions please contact us at 1-800-594-5550 or education@libertyhighschool.us. Welcome to Liberty.
