Student Enrollment Form
We're so glad you've chosen The Excel Center! Enrollment is open to any Indiana resident who does not have a high school diploma and is at least 18 years of age. Please fill out this form completely and someone from our team will contact you about next steps. 
First Name *
Last Name *
Date of Birth
Note that you must be 18 years of age or older to attend The Excel Center Evansville Southeast.
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Street Address *
Apartment/Unit or Other Address Information
City *
State
Note that only residents of Indiana are eligible to attend this location.  If you are from another state, click here to see if there is an Excel Center available to you.
 *
Zip Code *
Email Address
(Enter N/A if you do not have one)
 *
Phone Number *
Can this phone receive text messages? *
What is your primary language? *
What is the name of the most recent high school you attended?
(Enter N/A if you have not attended a high school before) *
Did you have an IEP or 504 plan at your most recent school?
If you had learning accommodations, we can reach out to your previous school for those records to implement at The Excel Center. *
Do you give The Excel Center permission to reach out to your previous school to retrieve copies of your student records?
Giving permission will help us to get a head start on the transfer of any previous IEP or 504 records.
 *
Are you listed on any Federal or State sexual offender registry?
Since we have a child care onsite, we are unable to accept any students who are currently listed on these registries or have a pending case which could result in being listed on such registries.
 *
How did you hear about The Excel Center Evansville Southeast?
(Check all that apply)
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