Adult Education Enrollment Application

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We're so excited that you've decided to partner with Bangor Adult Education! This application will take approximately 15-30 minutes to complete and the information will become part of your adult learning plan that is required by the state of Michigan Office of Adult Education.

How did you hear about Bangor Adult Education? *

Friend or family member

Facebook

Twitter

Radio advertisement

Mailing from Bangor Public Schools

Viking Press Newsletter in the Van Buren Reminder

Other:

Student Full Name: First, Middle Initial, Last *

Please provide maiden name if applicable, or N/A

Date of Birth *

YYYY

Place of Birth (City & State or Country) *

Social Security Number:

Mailing Address (including city, state and zip) *

Email address *

Primary Phone Number *

Gender *

Female

Male

Alternate contact's name and relationship

Alternate contact's phone number

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