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					Virtual Enrollment
                                                                                                                                       Form LL



            District:                                                                     School Year:

            Bldg/Program:                                                                 Count Date:



          Instructions:             Complete this form for all pupils enrolled in virtual high school classes. No more than two (2) classes may count toward pupil
                                    membership (Pupil Accounting Manual Section 50-1)

                                                                                            Enrolled in                                 In
                                                   H.S. Credit                              Traditional     On-Site Mentor         Attendance on         FTE For       Total
           Pupil Name                  Grade        Granted            Course Title (s)      Courses        Teacher Name            Count Day            Virtual       FTE
                                                      Y/N                                      Y/N                                      Y/N               Class
1
2
3
4
5
6
7
8
9
10

I certify this is a true and accurate list of pupils enrolled in virtual classes.


Signature/Title of Authorized Representative                                                                                    Date




                                                                                                                                                                12/12/2011

				
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