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East Side Adult Education ABE/ASE/CTE/GED Registration Form
Student Information - Please take time to complete the information below.
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* Indicates required question
Email
*
Your email
Registration Status
*
Returning Student
New Student
I would like to enroll in the following:
*
HSD (High School Diploma)
GED - (General Educational Development)
GED - Spanish
CTE (Career Technical Education)
ABE (Adult Basic Education)
Fine Arts/Personal Enrichment
Required
Adult Education Identification Number or Not Applicable (NA)
*
Your answer
Last Name
*
Your answer
First & Middle Name
*
Your answer
Address: Street
*
Your answer
City, State & Zip Code
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Your answer
Cell Phone Number
*
Your answer
Secondary Contact Number
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Gender
Choose
Male
Female
Non-binary
Emergency Contact Name
*
Your answer
Emergency Contact Relationship
*
Your answer
Emergency Contact: Phone Number
*
Your answer
Are you Hispanic or Latino?
*
Yes
No
Race (check all that apply)
American Indian
Alaskan Native
Black/African American
Asian
Fillipino
White
Native Hawaiian or Other Pacific Island
Other Asian
Native Language (check one)
Choose
English
Spanish
Chinese
Tagolog
Vietnamese
Cambodian
Korean
Hmong
Arabic
Russian
Farsi
Somali
Other
Highest Year of Schooling Completed (check one)
Choose
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Majority of my school was outside of the U.S
Yes
No
Did you attend high school at East Side Union High School District?
Yes
No
Clear selection
If yes, write the name of the high school or write NA
*
Your answer
Highest Degree Earned ( check one)
Choose
None
HSE Certificate
High School Diploma
Technical Certificate
A.A./A.S/Degree
4 year College
Higher than B.A./B.S
Some College, no degree
Earned outside of U.S
*
Yes
No
Please continue to complete more information. My attainable goals within the program year. Please select two.
Improve basic skills
Improve English skills
H.S Diploma/HSE
Get a job
Retain a job
Get a better job
Enter college or training
U.S. Citizenship
Employment Status
Choose
Employed
Employed with notice
Unemployed
Not in labor the force e.g. retired, full-time student, homemaker
Employment Barriers (Mark all that apply)
Cultural Barriers
Disabled
English Language Learners
Low Income
Low Levels of Literacy
Single Parent
NA (Not Applicable)
By my typed name below, I verify that all the information entered above is true and correct to the best of my knowledge.
*
Your answer
Registration Completion Date
*
MM
/
DD
/
YYYY
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 submit below.
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