☐ BC Care Card ☐ BC ID
☐ BC Driver’s License
☐ 2015-2016
101-814 Goldstream Ave, Victoria, BC V9B2X7
CROSS ENROLLED STUDENT LEARNING PLAN
First Name: Click here to enter text. Last Name: Click here to enter text.
Middle Name: Click here to enter text. Home Address: Click here to enter text. Postal Code: Click here to enter text.
City: Click here to enter text.
Province: Choose an item.
Country: Click here to enter text.
Home Phone: Click here to enter text. Cell Phone: Click here to enter text. Work Phone: Click here to enter text.
Personal E-mail: Click here to enter text.
Parent E-mail: Click here to enter text.
Maiden Name (last name before marriage): Click here to enter text. Ministry PEN #: Click here to enter text.
Parent / Guardian Name: (Under 19 only) Click here to enter text. Parent Contact: Click here to enter text.
Are you currently a distance learning student? Yes ☐ No ☐ Registered at: Click here to enter text.
Student Demographics:
Gender: Male ☐ Female ☐
Citizenship: Canadian ☐
Birth-date: Day Choose an item. Month Choose an item. Year Click here to enter text.
Landed Immigrant ☐ Student Visa ☐ Visitor’s Visa ☐ Letter Requested ☐
Do you have additional needs regarding: hearing, vision, disability, health (mental health), or learning disabilities?
Click here to enter text. Do you have an IEP? Click here to enter text.
*THIS SECTION MUST BE COMPLETED BY A SCHOOL COUNSELOR IN ORDER TO PROCESS THE
REGISTRATION
CROSS-ENROLLED STUDENT- APPROVAL TO ENROL IN JDFDL (DISTRIBUTED
LEARNING) OR WESTSHORE CONTINUING EDUCATION COURSE/S
Name of school presently registered: Click here to enter text.
Student claimed on Sept. 30 1701? Yes ☐ No ☐
Code: Click here to enter text. City: Click here to enter text.
Reason for enrolling:
Expected date of completion:
Counsellor/Administrator name: Click here to enter text.
Counselor/Administrator Signature: __________________________________ Date:
Student Signature:
Parent/ Guardian Signature:
By signing I am committed to the learning plan for my son/daughter.
Student under 19 confirms parent / guardian is aware of interview for Student Learning Plan.
Yes  No 
All courses follow Ministry of Education learning outcomes and resources available at: www.bced.gov.bc.ca/irp
Office Use Only
☐ MYED
☐ Access
☐ Blackboard ☐ Records Requested
WestShore Centre for Learning & Training/ JDFDL Phone: 250-391-9002 Fax: 250-391-9007
.
.
Student and Parent are required to read and initial after reading: Role of Student and Role of Parent.
Role of Student (DL courses)
Initial: ______________________
Once registered for a course, book a time to attend the DL orientation as soon as possible. The orientation provides a
valuable tutorial for navigating online courses and will make the transition into online course work easier. Create a schedule
for working on your DL courses. Allot time on a daily basis to complete assigned course tasks. Communicate regularly with
your DL teacher and do not hesitate to ask questions if you are not sure how to proceed with an assignment or do not
understand a course concept. Your DL teachers will be more than willing to assist you online or by phone.
Remember! There will be no teacher reminding you to get your work done so it is up to you to develop a schedule
and routine for completing your DL course work. You are expected to hand in an assignment each week unless you have
communicated with your teacher as to why not
Students’ key points to consider:
1. Keep to a set schedule (days & times).
2. Record upcoming due dates (calendar at a glance).
3. Create a comfortable work area where you do not have any other distractions.
4. Communicate regularly with your teacher.
5. Hand in assignments on time (or early!).
Role of Parent (Distributed Learning)
Initial: _________________________
Parents play a critical role with the success of students in any school setting. Distributed Learning (DL) courses place
parents in a supervisory role that would be managed by a classroom teacher in the regular setting. There are key elements
parents need to keep in mind when helping their children to be successful with courses that are completed at a distance. First,
work with your child to maintain a regular schedule of working on DL courses. For example, a DL student could spend the
morning working on DL if not enrolled in another school. If the student is enrolled at a regular school and supplementing their
school timetable with DL courses, they could dedicate one hour per evening for DL and some time on the weekends. A regular
routine of working on DL significantly increases the successful completion of the course.
Secondly, ensure that the student understands the there will be no teacher or timetable reminding them to get the work
done. Course success is achieved through the students own motivation. Self directed education is tough to get into when the
student has been attending classes in a traditional setting.
Finally, speak to your child about the pros and cons of DL courses. Explain that it requires individual motivation,
discipline, and commitment to be successful in these courses. Students will need to be willing to maintain regular contact
with the assigned DL teacher and will need to be comfortable working in both an electronic and binder course format.
WestShore Centre for Learning & Training/ JDFDL Phone: 250-391-9002 Fax: 250-391-9007
Student Name:Click here to enter text.
Work Experience (SD62 Schools)
Students age 16+ as of July 1, 2015 (DOB June 30, 1999 or earlier) Continuing Education
BELMONT
EMCS
ROYAL BAY
☐ Work Experience 12A
☐ Work Experience 12A
☐ Work Experience 12A
(MWEX-2A-B15)
(MWEX-2A-E15)
(MWEX-2A-R15)
☐ Work Experience 12B
☐ Work Experience 12B
☐ Work Experience 12B
(MWEX-2B-B15)
(MWEX-2B–E15)
(MWEX-2B-R15
Students age under 16 as of July 1, 2015 (DOB July 1, 1999 or later) Distributed Learning
BELMONT
EMCS
ROYAL BAY
☐ Work Experience 12A
☐ Work Experience 12A
☐ Work Experience 12A
(MWEX-2A-BPB15)
(MWEX-2A-EPB15)
(MWEX-2A-RPB15)
☐ Work Experience 12B
☐ Work Experience 12B
☐ Work Experience 12B
(MWEX-2B-BPB15)
(MWEX-2B–EPB15)
(MWEX-2B-RPB15
Secondary School Apprenticeship
Continuing Education
WESTSHORE
BELMONT
EMCS
ROYAL BAY
GRADE ELEVEN
GRADE ELEVEN
GRADE ELEVEN
GRADE ELEVEN
☐ SSA 11A
☐ SSA 11A
☐ SSA 11A
☐ SSA 11A
MSSA-1A-L15
MSSA-1A-B15
MSSA-1A-E15
MSSA-1A-R15
☐ SSA 11B
☐ SSA 11B
☐ SSA 11B
☐ SSA 11B
MSSA-1B-L15
MSSA-1B-B15
MSSA-1B-E15
MSSA-1B-R15
GRADE TWELVE
GRADE TWELVE
GRADE TWELVE
GRADE TWELVE
☐ SSA 12A
☐ SSA 12A
☐ SSA 12A
☐ SSA 12A
MSSA-2A-L15
MSSA-2A-B15
MSSA-2A-E15
MSSA-2A-R15
☐ SSA 12B
☐ SSA 12B
☐ SSA 12B
☐ SSA 12B
MSSA-2B-L15
MSSA-2B-B15
MSSA-2B-E15
MSSA-2B-R15
WestShore Centre for Learning & Training/ JDFDL Phone: 250-391-9002 Fax: 250-391-9007