Additional Registration Information
When you applied to the Adult Education Center, we asked you for basic information for our files. We need to get some more detailed information from you to fulfill state and federal requirements. This data is only used for the purpose of preparing reports and completing mandated follow-up reports. If you have any questions about how your data will be used, please stop now and ask the tutor/instructor for clarification.
What is your Adult Education ID number? Please ask the tutor/instructor for this number if you do not remember it. *
Your answer
What is your Social Security Number? *
We use this number to follow up on your progress after you leave the program. Without this number, we will be required by law to call you for followups every couple of months for at least two years after you leave our program. It is safe to give us your SSN in this form. Your number is stored securely and is not associated with your name/address so a hacker could not use it for identity theft. If you do not have a social security number, please type 1.
Your answer
What is your Date of Birth? *
MM
/
DD
/
YYYY
What is the name of the last public or private grade school/middle school/high school you attended? *
If you were homeschooled, please put "Home" in the blank.
Your answer
Where was this school (City/State/Country)? *
Your answer
What is the total income for your family unit?
Your family unit is the number of people living in the same household who are dependent on the group income listed below.
How many people are there in your family unit?
Your answer
Do any of the following apply to you (check all that apply)?
Do you have a record of any of these disabilities (check all that apply)?
Would you like to request a reasonable accommodation for any type of disability?
If you would like to request an accommodation, please discuss the accommodation with a tutor, instructor, or with the Manager of the Adult Education program.
Are you in any Correctional Program?
Please note: if you need any reports for a probation/parole officer, we will need at least 24 hours advance notice to prepare the report. If your probation/parole officer will be contacting us directly for reports, you must complete a consent form to allow us to release information. Please ask the Tutor/Instructor if you need a Consent Form.
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