SWMetro Adult Learner Entry Form
Email address *
Student Status *
Last Name *
Your answer
First Name *
Your answer
Middle Name *
Your answer
Nickname/Other Name
Your answer
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 *
Your answer
Apartment/Unit number
Your answer
City *
Your answer
Zip Code *
Your answer
Primary Phone Number *
Your answer
Email address *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Age *
Your answer
Gender *
Country of Birth *
Your answer
Primary Language *
Your answer
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:
Your answer
How did you find out about us? *
Emergency Contact Name *
Your answer
Emergency Contact Relationship to Student *
Your answer
Emergency Contact Phone Number *
Your answer
Technology *
Required
Questions or comments you may have for our ABE program staff?
Your answer
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