SLCC Adult Education 2021/2022 IN PERSON Student Interest Form

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Thank you for your interest in the Adult Education program here at SLCC. Please fill out the form and someone will contact you by email to set up an appointment. *** You should receive an email within 2-3 weeks regarding registration.*** MAKE SURE TO CHECK YOUR SPAM/JUNK FOLDER! THIS FORM IS FOR IN PERSON CLASSES ONLY. If you would like online classes, please visit https://www.solacc.edu/academics/adult-education/online-adult-education

Are you currently a student or were you a student with Adult Ed during the last 12 months (July 2020 to present)? *

Yes

Are you interested in the ESL Program? Only for students whose first language is NOT English. *

Yes

First Name *

Last Name *

Social Security Number

Date of Birth *

YYYY

Age *

Gender *

Female

Male

Prefer not to say

Other:

Email Address *

Phone Number *

Mailing Address *

City *

State *

Zip Code *

Which campus would you like to attend? (Choose One) *

Are you Hispanic/Latino? *

Yes

Race (Choose all that apply) *

American Indian/Alaska Native

Asian

Black/African American

White

Native Hawaiian/Pacific Islander

Required

Employment Status (Choose one) *

Employed

Unemployed

Not Looking for work

Not in Labor force

Place of employment (If you answered employed on the previous question)

Job Title

Education Details (Highest grade level completed) *

Location of highest grade completed *

U.S. Based

Non-U.S. Based

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