Bedford Adult Education Registration
Bedford Adult Education has open enrollment from September through April 1st. Please complete the questions
Classes run September through the beginning of May
Name (First, Last, Middle initial) *
Your answer
Maiden name (last name before you were married)
Your answer
Address (Number, street, city, state, zip code) *
Your answer
Telephone Number (home and cell) *
Your answer
Another phone number where you can be reached
Your answer
Email address (If you don't have one, type none) *
Your answer
Name of school district you live in *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Age *
Your answer
Birth City and State *
Your answer
Gender *
Do you have a high school diploma? *
Name of last high school attended *
Your answer
What is the highest grade you completed? *
Your answer
Are you currently enrolled in another adult education program? *
Have you been enrolled in another District’s adult education program this year? *
Ethnic Origin *
Attendance-I understand that good attendance is required in this program, and I agree to maintain good attendance. *
Bedford Adult Education is grant funded, and our grant requires that we do a follow-up survey for all students. I agree to participate in a follow-up survey that will be conducted after I leave the program. *
Registration Fee-There is a registration fee of $25. Classes and testing are then free to eligible Michigan residents. *
You will be asked to sign a form verifying your information the first night you come to class. Call 734-850-6050 with any questions. We hope to see you soon!
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