Florence County Adult Education Online Registration Form
Complete this form in its entirety as a part of becoming a high school diploma or GED/TASC student with Florence County Adult Education.  Before completing this form, make sure you have requested your official transcripts and school withdrawal information be sent to Florence County Adult Education via mail, fax, or phone.  Registration is complete for a student once the school has received four things: 1) transcript, 2) registration form, 3) Locator and TABE tests, and 4) online or in-person payment.  
Email *
Today's date *
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I am most interested in...
Last Name *
First Name *
Middle/Maiden Name *
Preferred Name
Mailing Street Address *
City *
State *
Zipcode *
County or School District of Residence *
Home Phone
Cell Phone *
Work Phone
Date of Birth (mm/dd/yyyy) *
Age *
Gender (M/F) *
Ethnicity: Please select one. (Definition: A Hispanic/Latino individual is a person of Cuban, Mexican, Puerto Rican, South or Central American or other Spanish culture/origin, regardless of race.) *
Required
Race: Check one or more boxes below to indicate your race. *
Required
Employment Status: Check only one box below to indicate employment status *
Education Level Completed (Check One) *
Location of Education: U.S. Schools? *
Name of last high school attended *
Have you attended adult education before? *
If you have attended adult education before, where?
If you attended adult education before, when?
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If you are between ages 18-21, are you currently expelled from school?
Clear selection
Do you receive Public Assistance? *
If yes, please indicate which type:
Clear selection
Immigrant *
If you are an immigrant, what is your birth country?
Please read each statement below and check the  box next to any statements that apply to you *
Required
Social Security Number Note: By giving my social security number below I also give permission for the release of my employment and post-secondary school information by the following agencies to the South Carolina Department of Education. I understand that my social security number will be used by the SCDE as well as Adult Education's state and local partner agencies.  My social security number will not be released to any other third party. Match agencies include SC Department of Employment and Workforce and Post-Secondary Institutions, to include but not limited to SC Technical Colleges or the Commission of High Education) *
I give permission to Florence County Adult Education to release my academic, attendance, and/or assessment information (including High School Equivalency Diploma Test Scores) to the following: (Check all that apply) *
Required
I give permission to Florence County Adult Education to release the following: (Check all that apply) *
Required
Student Expectations.  By typing your name below, you agree that all academic work you submit for this program will be generated by you and original to you. *
Verification of Information Given.  By typing your name below, you agree that all the information you have submitted on this registration form is truthful.
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