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Faribault County ABE SID Intake Form
This is our Adult Education enrollment form. We also use this form if you have a change of address or phone, etc. or if you haven't attended classes in the past 3 months. Thank you for completing this form. We will contact you within two days. If you have questions or problems with the form, please call (507)526-3172.
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Email *
Today's Date
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Social Security Number
If you do not have a social security number you can leave this blank. If you have a social security number but don't remember it, let us know so we can remind you to let us know in the future.
Last Name *
First Name *
Middle Name
Nickname or Other name
Is there a name you would prefer to be called?
Street Address *
City, State *
Zip Code
County
What county do you live in?  Hutchinson is in McLeod County, for example.
Primary Phone *
Secondary Phone
Is there another phone number you want us to call if we can't reach you at your primary number?
Email *
Date of Birth *
What month, day, and year were you born?
MM
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DD
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YYYY
Gender
Clear selection
What is your country of birth? *
Primary Language *
What native language do you speak?  If it's not listed just type in choice 'other.'
Hispanic or Latino *
Race *
Work Status *
Public Assistance *
Are you receiving any public assistance?
Highest formal education level
What is the highest level you reached in your education history?
Clear selection
Education Location
In what country did you go to school?  If multiple countries, put most recent education location.
Clear selection
NRS Tracking
Check all that apply to you.
Clear selection
Emergency Contact Name
Emergency Contact Phone number
MFIP
If you are enrolled in MFIP, what is your counselor's name?
MFIP Expiration Date
Please put your expiration date here, if known.
Goals - pick up to three goals you want us to help you with
This is important to our staff and your teachers to know what your goals are.
Submitting this form means that you have read and understand the Tennessen/Privacy Notice: In order for you to attend classes, the school is asking you to provide some information about yourself.  Because we are asking for this information, the law requires us to tell you the following:  a)the purpose and intended use of the requested information within the school; b) whether you may refuse or are legally required to supply the requested  information;  c) any known consequence arising from supplying or refusing to supply private or confidential information; and the identity of other persons or entities authorized by state or federal law to receive the information. Any information that you give to us may be shared with the Minnesota Department of Education and Faribault County Adult Basic Education consortium teachers.  The consortium is comprised of multiple Districts across the state collaborating to meet Adult Basic Education needs for its students. In order to go to this school, you have to give us your name, birth date, gender, ethnicity and employment status.  You do not have to give us any other information. You may leave at any time. We are required to ask for your social security number. You do not have to give us one. If you give us your Social Security number, it may be shared with the Minnesota Department of Education. Giving us your social Security number is optional.  Any other information that is requested will help this school. I have read and understand the above information. *
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