Student Application Form
GED®/HiSET® Prep and Adult Basic Education Classes
Student Basic Information
Location
Subject
Student Id
Name
*
First Name
Middle Name
Last Name
Today's Date
-
Month
-
Day
Year
Date
Date of Birth
*
/
Month
/
Day
Year
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Age
Have you previously applied to or attended adult education classes?
Yes
No
If yes, what year?
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Contact Information
Mailing Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Cell Phone Number
*
Please enter a valid phone number.
Email Address
*
Parent/Guardian Information
Parent/Guardian Name
First Name
Last Name
Parent/Guardian Phone Number
Please enter a valid phone number.
Parent/Guardian Email
example@example.com
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Emergency Contact
Emergency Contact Name
First Name
Last Name
Emergency Contact Phone Number
Please enter a valid phone number.
Relationship
Please Select
Parent/Guardian
Spouse/Significant Other
Grandparent
Sibling
Child
Other Relative
Friend
Other
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Demographic Information
Gender
*
Please Select
Male
Female
Are you Hispanic or Latino?
*
Yes
No
Race (Select all that apply)
*
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Highest School Grade Completed (select one)
*
Please Select
No formal schooling
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
Highest Educational Certificate/Diploma/Degree Completed (select one)
*
Please Select
None
High School Diploma
High School Equivalency
Certificate of Attendance/Completion
Some Postsecondary Ed
Technical/Vocational
Associate's Degree
Bachelor's Degree
Master's Degree
Specialist's Degree
Doctorate's Degree
Unknown
Was your highest education level completed in the United States or at a US-based school?
*
Yes
No
What is your work status?
*
Have you (or someone in your household) received any of the following in the last six months? (Select all that apply.)
TANF (Temporary Assistance for Needy Families)
*
Yes
No
SNAP (Supplemental Nutrition Assistance Program) Food Stamps
*
Yes
No
SSI (Supplemental Security Income)
*
Yes
No
State or Local income-based public assistance
*
Yes
No
Have you received TANF for more than 2 years in total?
*
Yes
No
How many family members, including yourself, have lived in your household in the last six months?
*
Do any of the following statements apply to you? (Select all that apply.)
*
I have a low income.
I am a former homemaker who is having trouble finding a job or a better job.
I am a single parent and I am unmarried or separated from my spouse and have primary responsibility for one or more dependent children under the age of 18 or I am a single, pregnant woman.
I am homeless and I live in a motel, hotel, campground, transitional housing, or with another person because I lost my house or apartment.
I have a criminal record that makes it hard to find a job.
I am in the foster care system (or I used to be) and I am less than 24 years old.
I am a seasonal farmworker who has worked the last 12 months in agriculture or fish farming labor.
I am a seasonal farmworker with no permanent residence (migrant).
I am a dependent of a farmworker.
None of these apply.
Language Spoken at Home
Country of Birth
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Secure and Verifiable Documents
Upload document/s to receive state and federally funded adult education services.
Click Here for Secure and Verifiable Documents Information
Which document/s are you uploading?
*
Please Select
U.S. Driver's License
U.S. Permanent Resident Card
U.S. Passport
U.S. Military ID
Employment Authorization Card (I-766)
J-1 Visa Form (DS-2019)
Foreign Passport
Other
None now. Will provide necessary document/s in-person.
U.S. Driver's License
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U.S. Permanent Resident Card
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U.S. Passport
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U.S. Military ID
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Employment Authorization Card (I-766)
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J-1 Visa Form (DS-2019)
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Foreign Passport
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I-94, I-94A, or I-94-W
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U.S. Visa
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Other
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HOPE HSE Grant Documents
Upload additional documents required for HOPE HSE Grant approval.
Click Here for HOPE HSE Grant Info
GA Residency Documentation
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Upload one document dated 12-24 months in the past that demonstrates 12 months of Georgia residency (Example: bank statement, utility bill, lease, previous year's GA tax return, etc.).
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U-18 Parent/Guardian GA Residency Documentation
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Upload one document dated 12-24 months in the past that demonstrates 12 months of Georgia residency for the parent/guardian of the U-18 student (Example: bank statement, utility bill, lease, previous year's GA tax return, etc.).
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U.S. Citizenship Documentation
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Upload one of the following: US Birth Certificate, Us Passport or Passport Card, Certificate of Naturalization, Permanent Resident Card (Green Card), or Foreign Passport w/I-94 (Refugee, Asylee, or Parolee).
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