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HSE Registration (Winter 2020)
Please use this form to register for High School Equivalency (GED) classes.
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Email *
Location *
Please choose one
Required
First Name *
Last Name *
Date of Birth *
MM
/
DD
/
YYYY
Social Security Number
Were you referred to us from another program? *
For example: OneStop, Unemployment, another school, etc
If so, what is the name of the program? *
*If you were not referred, please put NA in the box below to continue
Home Phone Number *
Please include area code
Mobile Number *
Please include area code
Email Address *
*If you do not have an email address, please put NA in the box below
What is the best way to contact you? *
Address *
City *
Zip Code *
Primary Goal *
What is the main reason you are attending this program? (please check all that apply)
Required
Primary Program *
Please choose only one
Ethnicity *
Race *
Employment Status Upon Entry *
Other Information *
Please check all that apply
Citizenship Status *
Did you attend: *
Employment Information *
Please list Company name, Address, Telephone #, Position, Average Hours per Week, Start Date
Schooling *
Allergies or conditions we should know about
College or Vocational Schools Attended
Referred from: *
Check all that apply
A copy of your responses will be emailed to the address you provided.
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