Granite Peaks Adult Education Registration Form
What would you like to study?
English as a Second Language (ESL)
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.
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?
What is your legal middle name?
What is your legal last name?
What is your date of birth (Month, day, year)
What is your gender?
What is your mailing address? Please include your city, and Zip Code.
What county do you live in?
What is your phone number?
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.
What is your email?
What is your ethnicity?
What is your race?
If you are Native American, please select your tribal affiliation
NW Band of Shoshone
Are you a Refugee?
If you are a Refugee.... what is your Refugee Date AND Alien Number?
What is your native language?
Are you a Migrant Worker? (Do you move quite often for your job?)
YES- Seasonal Farm Worker
YES- Migrant and Seasonal Farm Worker
YES- Dependent of Migrant/Seasonal Worker
What is the highest grade in school that you completed?
I did not go to school
I have a High School Diploma
I have a GED Diploma
I have completed some college
I have an Associates degree
I have a Bachelor's degree
I have earned degrees beyond Bachelor's degrees
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?
What was the last Utah public K-12 School that you went to?
What is your Student ID (9 digit number)?
What is your current employment status?
I am employed.
I am employed, BUT received a termination notice.
I do not have a job, and I AM NOT looking for a job.
I do not have a job, and I AM looking for a job.
I have been unemployed for more than 27 weeks
Specific Learning Disabled
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?
I am in a Community Correctional Program.
I am on probation.
I am in a correctional facility.
I am in another institutional setting.
Do you have an account/case worker with any of the following agencies?
Department of Workforce Services
CCS (Catholic Community Services)
IRC (International Refugee Committee)
I am ON PUBLIC ASSISTANCE
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.
I give permission to release my data.
I do NOT give permission to release my data.
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.
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This form was created inside of Granite School District.