Out-of-State Enrollment Form

KET 2008-2009 Course Enrollment Form

Please fill out this form to register for each course. If you can not submit the form, print out and return completed form to:
KET Distance Learning, 600 Cooper Drive, Lexington, KY 40502-2296
or FAX to: 859.258.7390
For questions, call 800.333.9764

School Name: Principal: District:
Mailing Address: City, State, Zip:	Shipping Address (if different): City, State, Zip:
Coordinator: (primary contact between school & KET) Name: Phone: E-mail: Fax:	Facilitator: (classroom monitor & mentor) Name: Phone: E-mail: Fax:
2008-2009 Starting Date:	Class Meeting time:

Name of Course:

Virtual Physics Labs Fee:
  $50/School plus $10/Student if enrolled in AP^® Physics B
  $75/School plus $10/Student if not enrolled in AP^® Physics B

Student Guide Fees:
  $10/Student for German I, II, III
  $10/Student for Latin I, III, AP^® Latin Literature
  $10/Student for AP^® Physics B
  $5/Student for Latin II

Physics VHS Instructional Tapes ($198): Yes No
Humanities: VHS tapes ($198) or DVDs ($198)
German I: CDs ($50)   Number of sets:
  or VHS tapes ($198) or DVDs ($198)
   (If replacing German I tapes: $100 for VHS or DVDs with return of previous set.)
German II, III; Latin I, II: CDs ($50)   Number of sets:
  or VHS tapes ($198)
AP^® Physics B, Honors Physics:
  CDs ($50)   Number of sets:
  or DVDs ($20)  Number of sets:

To reserve a student slot without a name, please write "Student #1, Student #2", etc. for each slot you wish to reserve. Reserving a student slot entails the same financial commitment as registering a student by name.

STUDENT'S NAME	GENDER	GRADE
1.	M F	7 8 9 10 11 12
2.	M F	7 8 9 10 11 12
3.	M F	7 8 9 10 11 12
4.	M F	7 8 9 10 11 12
5.	M F	7 8 9 10 11 12
6.	M F	7 8 9 10 11 12
7.	M F	7 8 9 10 11 12
8.	M F	7 8 9 10 11 12
9.	M F	7 8 9 10 11 12
10.	M F	7 8 9 10 11 12
11.	M F	7 8 9 10 11 12
12.	M F	7 8 9 10 11 12

How will you pay? Amount to KET	If registration/enrollment is made by July 15, 2008, there is a 5% discount on all items, except the Virtual Physics Labs Fees.
Purchase Order # (Required) Check (KET will send an invoice.) Credit Card (KET will contact you for the information, or you may call 800.333.9764.)
Billing Contact:		Cost Calculator
Billing Address:	(Opens new window). Requires Flash. If using IE, a page will automatically download the plug-in. If using Netscape, you will need to download and then install the free Flash Player plug-in.
City: State: Zip:
Phone: () - Ext: Fax: () -

I have read and understand the registration information and understand the fees associated with the course.

Signature:

Date:

Letter of Agreement

This agreement states that (name of school, district, or individual) is responsible for paying tuition and materials fees for students enrolled in KET courses. All additions, substitutions, and withdrawals must be noted by the coordinator on school letterhead and returned to KET via mail or fax, 859.258.7390. No new students will be registered after September 16, 2008, without permission from the course instructor.

Student Withdrawal Policy - Deadlines will Be Strictly Enforced
First Semester:
Withdrawals postmarked by September 12, 2008	No Charge
Withdrawals postmarked between September 13 and 26, 2008	50% Tuition Charged
Withdrawals postmarked after September 26, 2008 (invoices sent out after Sept. 26)	100% Tuition Charged
Second Semester: *
Withdrawals postmarked by January 23, 2009	No Charge
Withdrawals postmarked between January 24 and February 6, 2009	50% Tuition Charged
Withdrawals postmarked after February 6, 2009	100% Tuition Charged
* Year Long classes adhere to First Semester Drop Rates
There will be a $100 re-enrollment fee for students who do not complete a course by June 15, 2009 and wish to continue the following school year.

I have read and understand the KET policy referenced above and commit to pay tuition and fees as outlined.

Signature:

Title:

Date:

If you can not submit the form, print out and return completed form to:
KET Distance Learning
Linda Hofacker
600 Cooper Drive
Lexington, KY 40502-2296
or FAX: 859.258.7390
For questions, call 800.333.9764

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