9391 Washington Church Rd. 1101 John Wesley Ave.

Miamisburg, OH 45342 Xenia, OH 45385

(937) 291-7285 (937) 352-1640

Student Name: ________________________________ Year of Graduation: _________ Today’s Date: ________

Home Phone: ___________________________________ Cell Phone: __________________________________

Online Course Name: _______________________________________ Provider: __________________________

Online courses may be taken during the school day or as an independent study outside of the school day. Please
indicate your plan. (circle) at school or independent study

In what term do you plan to take this course? (circle) 1st Semester…..2nd Semester....J-term…..Summer Semester

What is the reason for taking this course online? ____________________________________________________

____________________________________________________________________________________________

Statement of Understanding

We understand that online coursework requires a high level of self-discipline and motivation by a stu-
dent. Academic intervention and support is not as readily available as it is with the traditional class-
room setting.
We understand that these online courses are accomplished in conjunction with 3rd party organizations
and may include slight differences in course objectives and integration from traditional Dayton Chris-
tian courses.
We understand that online courses require additional tuition payments by the family/student to the 3rd
party providers beyond the regular tuition payments to Dayton Christian Schools. Payment for any
Sevenstar course is to be included with this application and made payable to “Dayton Christian
Schools.”
In order for a student to receive credit from Dayton Christian Schools for any online course, adminis-
trative approval must be granted in writing before a student registers for the course.
The signatures below indicate an understanding and agreement with this framework for online course
enrollment.

Parent Signatures: _____________________________________ ____________________________________

Student Signature: ___________________________________________________________________________

Office Use Only

Administrative Approval Signature: __________________________________________ Date: _______________

Course Name: ____________________________________ Provider: _____________________ Cost: ________

Academic Achievement Review: _______ Conduct Review: _______ Attendance Review: _______ Payment received: _______

Passed All Sections of OGT: _____ Credit attempted for: _______ Remediation _______ Replacement _______ Elective
 9391 Washington Church Rd. 1101 John Wesley Ave.
Miamisburg, OH 45342 Xenia, OH 45385
(937) 291-7285 (937) 352-1640

Pricing for the 2010-2011 school year:

Traditional High School Courses…….………Year long: $477.00……...…....Semester: $377.00

AP Courses………………………………….……………..…..………………………….$577.00

Dual Credit Courses through Indiana Wesleyan and Taylor Universities…………….….$577.00

Payment for these courses should be made to Dayton Christian Schools and submitted with the
online course application to the high school office.

Some courses require an additional purchase of a textbook and lab fees. See course catalogue.

Cedarville University Dual Credit Courses……………………..………………………..$450.00

Payment for these courses should be made directly to Cedarville University in accordance
with their registration policies after the online course application has been approved by the high school office.

This does not include textbook costs.

Total Cost
Course Name: ______________________________________________________ Cost: ______________

Yearly...One Time...Non-refundable registration fee for any on-line course.………………….………………$25.00

TOTAL ______________

Please make checks payable to Dayton Christian Schools.