Language
English (US)
Spanish (Latin America)
Chinese
Arabic
Korean
French (France)
Registration Form
Welcome! Thanks for your interest in MCCSC Adult Education. Registration for summer classes is CLOSED. Fall classes begin on August 12th. Registration for fall classes will open on June 15th. The last day to register for fall classes is August 9th.
Which type of class are you interested in joining?
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Please Select
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What high school equivalency class are you interested in?
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Start ASAP (with a commitment to continue attending class through June 27th), Morning (Teacher - Chris). It meets Monday through Thursday (pick 3 days), 9:00-noon at Broadview Learning Center.
Start June 3, Evening (Teacher - Ellen). It meets Tuesday, Wednesday, and Thursday, 4:30-7:30 p.m., at Broadview Learning Center.
Start June 3, Morning Class. It meets Monday through Thursday, 9:00-noon at Broadview Learning Center.
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Awesome choice! We are excited that you are ready to get started as soon as possible (ASAP). Please come to the next class. Our morning class starts at 9:00 a.m. at Broadview (Monday-Thursday). Please hit the next button to finish the application process. See you soon!
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Which certification or specialized class are you interested in?
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Fall 2024: Introduction to 3-D Printing
Fall 2024: CompTIA A+ Certification Class (Monday and Wednesday 5:00-7:00 p.m.)
August 2024: Heating, Ventilation, Air Conditioning (HVAC) - EPA 608 Certification (Monday-Thursday 5:30-8:30 p.m. Online Learning Options)
August 2024 Certified Clinical Medical Assistant (CCMA) Certification (Monday and Friday 5:00-9:00 p.m.)
August 2024: EMT Certification Class
Dates TBD: CDL-B Permit
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Before you can begin your English class, you need to take a pre-test. When would you like to take your pre-test?
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Name
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First Name
Last Name
Middle Initial
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Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Social Security Number or Tax Identification Number
Primary Phone Number
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Please enter a valid phone number.
Cell Phone Number
Please enter a valid phone number.
Prefer Text Message?
*
Please Select
Yes
No
Email Address
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example@example.com
Date of Birth
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-
Month
-
Day
Year
You must be 16 or older and not enrolled in high school in order to be eligible for adult education.
Current Age
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If you are under the age of 18, you must provide and exit interview and withdraw form to prove you are not currently enrolled in high school. This must be submitted to our office before you begin classes.
Gender
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Please Select
Female
Male
Non-Binary
Maiden Name
Ethnicity
*
Please Select
Hispanic (a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race)
Other (Not Hispanic)
Race (if Ethnicity is "Other," choose one of these)
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Please Select
African American
American Indian
Asian
Pacific Islander
White
Native Country
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What is your primary language (the language you use most often)?
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U.S. Citizen? (We gladly serve everyone.)
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Please Select
Yes
No
Are you a refugee?
Please Select
Yes
No
Have you attended MCCSC Adult Education classes before?
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Please Select
Yes
No
Medical concerns we should be aware of:
What is your main long term goal?
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Enter Employment
Retain Employment
Career Advancement
Personal
Military
College
Certification/Advanced Training
Other
Employment Status
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Please Select
Employed
Employed, but termination or military separation is pending
Not employed (but available to work)
Not employed for more than 26 weeks
Not in the labor force
Employer
Employer Phone
Please enter a valid phone number.
Educational Status (your highest level of education)
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Please Select
No schooling
Grades 1-5
Grades 6-8
Grades 9-12 (no diploma)
Certificate of Completion (Disability IEP)
High school diploma or alternate credential
High school equivalency
Some postsecondary, no degree
Professional certificate or license (no degree)
Associate's degree
Bachelor's degree
Beyond bachelor's degree
Unknown
Last grade completed
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Last school attended
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Previous school
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Please Select
In the U.S.
Outside the U.S.
Military Veteran?
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Please Select
Yes
No
Resident of an institution
*
Please Select
Community corrections facility
Correctional facility
Medical, group, or nursing home
None of these
How did you hear about Adult Education?
*
Please Select
Brochure/flyer
Court referral
Department of Workforce Development website
Employer
Friend/relative
Literacy program referral
MCCSC Adult Education website
Newspaper
Social media
Public assistance referral
Shelter
TV or radio
WorkOne referral
Other method
Other referral
Demographics (Please check all that describe you.)
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Impairments (I have a physical, mental, or learning disability.)
Lives in urban area (I live in an area with 2,500 or more people.)
Lives in rural area (I live in an area with less than 2,500 people.)
Receives public assistance (other than social security or unemployment)
Low income (I could receive cash assistance or am homeless.)
Displaced homemaker (I lost the income that my spouse was providing as support.)
Single parent (I have sole custody of my children.)
Dislocated worker (I am laid off or about to be laid off from my job.)
I am a dependent or have dependents.
I am receiving unemployment insurance
Foster care youth
Homeless or runaway
English not used at home
Migrant or seasonal farm worker
I am active military.
My spouse is active military.
Cultural barriers to employment
Emergency contact (A friend or relative who will always know how to contact you, even if you move.)
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My emergency contact is my:
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Please Select
Parent
Grandparent
Spouse
Aunt
Uncle
Friend
Other
Emergency Contact Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact Phone Number
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Please enter a valid phone number.
Our classes might be taught online whenever we cannot meet in person. If class is online, here is a list of what you would need. Please check the items you have:
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Computer, laptop, or tablet
Camera and audio for videoconferencing
Phone
Google Chrome
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