Thank you for your interest in The Door’s HSE Program!
Please fill out the form below and a staff member will contact you with next steps.
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Email *
First Name *
Last Name *
Are you a Door Member? *
If yes, what is your Door ID Number ? (if you don't remember it, write below  "I don't remember"
What site are you interested in? *
Date of Birth *
Age? *
What is your phone number? *
What's the best way to contact you? *
Last academic grade completed? *
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Are you a High School graduate ? *
If applicable, last New York City School attended?
If applicable, have you passed any New York State Regents?
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If yes, which ones (check all that apply)
In the past have you ever been enrolled in a GED Program? *
If yes, where?
Have you ever taken the GED or TASC exam? *
If yes, where and when?
Are you able to be a fulltime student at this time? (a full time student means the ability to commit to educational programming from 9am-3pm) *
Are you working right now? (employment may effect eligibility for certain classes) *
Do you have access to a laptop or computer? *
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Do you have a stable internet connection? *
Have you ever been involved in any of the following (check all that apply) *
Additional questions you have about the program:
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A copy of your responses will be emailed to the address you provided.
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