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Application for Admission
Please read the application carefully before completing.
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* Indicates required question
Email
*
Your email
Program:
*
ELL ExCEL Program
HS Success
Pathway to College
HS Plus
Unsure/Don't know
Required
I. PERSONAL INFORMATION
Legal Last Name
*
Your answer
Legal First Name, Middle Initial
*
Your answer
Gender
*
Female
Male
Other:
Home Address:
*
Must provide your full home address.
Example, House Number, Street Name/Number, City Name and Zip Code.
Your answer
Phone Number:
*
Your answer
Date of Birth (MM/DD/YYYY)
*
Your answer
Ethnicity:
*
American Indian or Alaska Native
Asian
African American/Black
Hispanic/Latino(a)
Middle Eastern
Pacific Islander
Caucasian/White
Specify Ethnicity " (more depth)"= Ethnicity- Hispanic/Latino(a) to be more specific- (Guatemalan)
Your answer
Are you an ELL Student? (English Language Learner)
*
Yes
No
Native Language
*
Your answer
Language Spoken in the home
Your answer
How did you learn about the program?
Your answer
Emergency Contact Information
(Parent/Guardian for students under 18 years old)
Parent/Guardian/Emergency Contact Name:
*
Your answer
Relationship to the student:
*
Your answer
Telephone Number:
*
Your answer
Language Spoken:
Your answer
II. EMPLOYMENT
Do you currently have a job?
*
Yes
No
Employer:
Your answer
About how many hours a week do you work?
Your answer
Location (City/State), Type of work:
Your answer
Any questions or need help?
Please email us at
hseas@highline.edu
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