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CIU 10 Adult Education Registration
Please complete this registration form and a Student Support Coordinator will contact you ASAP to set up an appointment with you.
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* Indicates required question
Email
*
Your email
Full Name
*
Your answer
Full Address
*
Your answer
In which county do you reside?
*
Centre County
Clearfield County
Clinton County
Best telephone number to contact you?
*
Your answer
Email Address
Your answer
What is the best way to contact you to discuss the program and the classes we offer?
*
Telephone at number listed above
Email at address listed above
Either is fine
Text at number listed above
Other:
What technology do you have available? Please check all that apply.
*
Computer (PC/Laptop)
Internet (Hot Spot/Unlimited Data/High Speed)
Speakers (separate or in computer)
Web Cam (separate or in computer)
Microphone (separate or in computer)
Use cell phone for all technology
Required
What is your specific need in wanting to enroll in our classes?
*
I need my Secondary High School Diploma (GED or HISET)
I need to sharpen my basic skills (Math and/or English)
I want to get into a post-secondary school and need to brush up on skills.
How did you find out about our program?
*
Word of mouth
Newspaper Ad/Radio
My employer
PA CareerLink
Other:
Required
Submit
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