MCCSC Adult Education Registration Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

We are so excited you are interested in our program! Our teachers and staff strive everyday to help all students reach their goals. Please complete the following form in order to join classes at the Broadview Learning Center. We are currently on summer break, but you can register now for classes that begin in August.

Email *

What is your first name? *

What is your last name? *

What is your date of birth? *

YYYY

What is your phone number? *

What is your gender? *

Male

Female

Prefer not to say

What language do you primarily speak? *

I am a resident of Indiana and am currently residing in the state. *

I understand that I must be in Indiana to take classes.

Required

You must be at least 16 years of age to attend adult education classes. Are you at least 16 years old? *

Yes

You must be withdrawn from K-12 public schools to attend adult education classes. Are you withdrawn? *

Yes

Maybe

If you are 16 or 17 years old, you must bring a legal parent/guardian with you on the first day to complete the required paperwork. Please check the box indicating you understand. *

I understand I will need to bring my legal parent/guardian on the first day of class.

I am at least 18 years old so this does not apply to me.

Required

Have you been a student in any of our classes in the past? *

Yes

Maybe

What type of class are you interested in joining? *

GED preparation / Adult Basic Education Classes / ParaPro Training

English Language Learning Classes

MyCook Pathway (Cook Employees only)

Clear form

Never submit passwords through Google Forms.

This form was created inside of Monroe County Community School Corporation.

Does this form look suspicious? Report

Forms