Adult Education and Literacy Program Pre-Registration Form

1

Notice: ALL individuals must complete orientation and placement testing prior to attending AEL classes.* This field is required.

I understand I will not be enrolled in the AEL Program until I have completed all orientation activities and placement testing.

2

What classes are you interested in attending?* This field is required.

High School Equivalency Diploma

English as a Second Language

Literacy - learning to read

4

First Name* This field is required.First Name

5

Middle Name* This field is required.Middle Name

6

Last Name* This field is required.Last Name

7

Street Address* This field is required.Street Address

8

City* This field is required.City

9

State* This field is required.State

10

Zip Code* This field is required.Zip

11

Phone Number* This field is required.

Please enter a valid phone number.

12

Email* This field is required.If you do not have an email address, please create a free one at either www.google.com or www.outlook.live.com.

example@example.com

Confirm Email

13

Have you attended SCC's Adult Education and Literacy classes before?* This field is required.

YESNO

14

If yes, what year?

15

What year were you born?* This field is required.

16

How old will you be on September 15 of this calendar year?* This field is required.