SWMetro Adult Learner Entry Form
Email address *
Student Status *
Last Name *
First Name *
Middle Name *
Nickname/Other Name
Tennessen Warning requires ABE programs to ask for the following information for program records including name, birth date, race/ethnic group, current employment status, highest education level, and education location. We may share this information with teachers and other staff who need it to do their jobs. Adult programs are required to collect and report this information to the MN Department of Education for annual reporting and for funding. We will only share this information with another organization or individual if you give us written permission. I have read this Tennessen Warning and agree. *
Required
What type of class are you interested in? *
Required
Street Address *
Apartment/Unit number
City *
Zip Code *
Primary Phone Number *
Email address *
Date of Birth *
MM
/
DD
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YYYY
Age *
Gender *
Country of Birth *
Primary Language *
Hispanic / Latino *
Race (check all that apply) *
Required
Work Status *
If Unemployed, the last date you worked
MM
/
DD
/
YYYY
Public Assistance (check all that apply) *
Required
Highest Formal Education Level Completed *
Highest Level of Education Location completed in: *
NRS Tracking (check all that may apply)
Have you attended other Adult Education classes somewhere else in Minnesota? *
If you have attended Adult Education classes elsewhere in Minnesota, please include approximate date, program name, and location/city:
How did you find out about us? *
Emergency Contact Name *
Emergency Contact Relationship to Student *
Emergency Contact Phone Number *
Technology *
Required
Questions or comments you may have for our ABE program staff?
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