Registration Form 
Fall Classes Begin September 2nd

English Learning Classes   
• Morning classes:  Monday - Friday,  9:00am - 1:00pm  (in person only)
• Evening classes:  Monday - Thursday,  6:00pm - 8:30pm  (Two nights online, two nights in-person)

Other Classes
• Adult Diploma/GED Prep Classes:  Tuesdays,  3:00pm - 6:00pm (in person & online) 
• Apprentice & Manufacturing Ready:  Monday - Friday,  8:30am - 12:30pm (in person only)
• Microsoft Office Specialist Certificates:  Monday - Thursday,  1:30pm-3:30pm (in person & online) 

For more information, please visit isd623.org/ralc.
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Email *
Program Registering For: *
Have you been a student here before? *
Have you attended any other Minnesota adult schools? *
If yes, what is the name of that adult school?
Last Name *
First Name *
Middle Name
Former Names (if applicable)
Birthday (MM/DD/YEAR) *
MM
/
DD
/
YYYY
Social Security # (enter your SS# on the "other" line) *
Gender *
Address *
City *
State *
Zip Code *
Phone Number  *
Emergency Contact Name *
Emergency Contact Phone Number *
Emergency Contact's Relationship to Student *
Ethnic Background *
Required
Country of Birth *
Home Language *
Highest level of education here in the U.S. or in your home country: *
Have you received education in the U.S.? *
If yes, where did you attend school?
Check the goals you would like to work on while enrolled here in our program *
Required
Employment Status: *

Barriers to Employment  (what stops you from working) check all that apply.    

 *
Required
Do you have one of the following? *
Agency Name
Name of job counselor/case worker/parole officer:
Phone number of job counselor/caseworker/parole officer:
Please check all that you receive / all that apply to you: *
Required
Do you have any health issue we should be aware of? *
If yes, please describe:
How did you hear about us?
A reading assessment test is required for all students entering our program. Please select the time that works best for you to come in: *
Leave a comment or question.
Note: Office hours are Monday-Friday from 9:00am-4:00pm. Testing can take up to 2 hours.
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