Granite Peaks Adult Education Registration Form
What would you like to study? *
If you would like to earn your Credit Diploma, we are able to obtain your transcripts for you. In typing your full name below, you are authorizing Granite Peaks Adult Education to send a request for your transcripts.
Your answer
Has your class graduated from High School? *
Have you ever attended Adult Education in Utah (Horizonte, Entrada, Granite Peaks, South Pointe etc...?) *
What is your legal first name? *
Your answer
What is your legal middle name? *
Your answer
What is your legal last name? *
Your answer
What is your date of birth (Month, day, year) *
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What is your gender? *
What is your mailing address? Please include your city, and Zip Code. *
Your answer
What county do you live in? *
What is your phone number? *
Your answer
When is it a good time to contact you? *
If we are unable to contact you on the above phone number, who can we call to get in touch with you? Please list a name and alternate phone number. *
Your answer
What is your email? *
Your answer
What is your ethnicity? *
What is your race? *
If you are Native American, please select your tribal affiliation
Are you a Refugee? *
If you are a Refugee.... what is your Refugee Date AND Alien Number?
Your answer
What is your native language? *
Are you a Migrant Worker? (Do you move quite often for your job?) *
What is the highest grade in school that you completed? *
Did you go to School in the United States? *
Did you have an IEP (Disability and Individualized Educational Plan) in school?
What type of school did you go to?
What was the last Utah public K-12 District that you went to?
Your answer
What was the last Utah public K-12 School that you went to?
Your answer
What is your Student ID (9 digit number)?
Your answer
What is your current employment status? *
Disability Status *
Are you a Displaced Homemaker? (1- You have been dependent on the income of another family member but is no longer supported by that income, or 2- you are the dependent spouse of a member of the Armed Forces on Active duty, or you are unemployed or 3- underemployed and is experiencing difficulty in obtaining or upgrading employment) *
Do you have a Cultural Barrier to your education?
Are you an ex-offender?
Are you a Single Parent? *
Are you low income? (Do you make $30,000 or less per year?) *
Have you been or are you currently on TANF? *
Are you homeless or a runaway? *
Are you in foster care OR aged out of the Foster Care System? *
Have you been in Corrections?
Do you have an account/case worker with any of the following agencies?
I release all personal data (including my social security number), Plan for College and Career Readiness information and GED scores, if applicable, to the Utah State Board of Education and other state agencies for client counseling and data matching purposes, in addition to any Adult Education program that I may choose to attend. *
At Granite Peaks, our hope is that if you have grievances or concerns, that you would speak to the Coordinator, Director etc.. If we are unable to resolve your grievances, you have the right to follow the program grievance policy. *
Please type in your name as a digital signature. If you are under the age of 18, you will need to have your parent or guardian digitally sign as well. *
Your answer
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