Adult Education Identification Number or Not Applicable (NA) *
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Last Name *
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First & Middle Name *
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Address: Street *
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City, State & Zip Code *
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Cell Phone Number *
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Secondary Contact Number
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Date of Birth *
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Gender
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Emergency Contact Name *
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Emergency Contact Relationship *
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Emergency Contact: Phone Number *
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Are you Hispanic or Latino? *
Race (check all that apply)
Native Language (check one)
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English
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Highest Year of Schooling Completed (check one)
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Majority of my school was outside of the U.S
Did you attend high school at East Side Union High School District?
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If yes, write the name of the high school or write NA *
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Highest Degree Earned ( check one)
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HSE Certificate
High School Diploma
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Earned outside of U.S *
Please continue to complete more information. My attainable goals within the program year. Please select two.
Employment Status
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Employed
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Employment Barriers (Mark all that apply)
By my typed name below, I verify that all the information entered above is true and correct to the best of my knowledge. *
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Registration Completion Date *
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Thank you! To be officially registered please call the office ( 408-928-9300) for the counseling appointment or to take the placement test. Please click on submit below.
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