test | DelcoVP

Was this student previously enrolled in Delco VP for any other course(s)? *

Student First Name *

Student Middle Name

Student Last Name *

Address Line 1 *

City *

State *

Zip Code *

Student Birthdate (m/d/yyyy) *//

Gender *

Student Email Address *

Student Phone

School District *

School Name *

Counselor Name

Grade *

Parent/Guardian Name *

Parent/Guardian Email Address *

Parent/Guardian Primary Phone *

Parent/Guardian Secondary Phone

Second Parent/Guardian Name

Second Parent/Guardian Email Address

Second Parent/Guardian Primary Phone

Second Parent/Guardian Secondary Phone

COST TO FAMILIES

PAYMENTS ARE NON-REFUDABLE
SPARK Course - $290 per course
9 week program
Note: Students must have computer and Internet access

Select up to three (3) Credit Recovery Courses. Please confirm course selection with your School.

Choose Course Grade Level *

Number of Courses *

High School Course 1 *

High School Course 2 *

High School Course 3 *

Middle School Course 1 *

Middle School Course 2 *

Middle School Course 3 *

Total

$ 0.00

Stripe Credit Card *

Card

Name on Card

Notes to Registrar