AEL Registration Form

High School Equivalency & English as a Second Language Programs Registration Form

Fill out the form carefully for registration
Location Choice *
Class Type *

High School Equivalency Diploma English as a Second Language Spanish HSED Citizenship Other
Time Available *

Morning Afternoon Evening
Days Available-mark all that apply *

Monday Tuesday Wednesday Thursday Friday-online only Saturday-online only Sunday-online only
Delivery Preference *
Student Name *

First Name Middle Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Birth Date *

Month Day Year
Gender *
Student E-mail
example@example.com
Phone Number *
Social Security Number
Do not have a SSN
Ethnicity: *

Hispanic/Latino Not Hispanic/Latino N/A
Race *

White Asian Black or African American Filipino American Indian Alaska Native Native Hawaiian Pacific Islander
What is the primary language spoken in your household? *
Highest Grade Completed *
Highest Degree or Diploma *

None HSE Certificate High School Diploma Technical/Certificate Some college, no degree A.A/A.S Degree 4 year College Graduate High than B.A/B.S Individual Education Plan Other Diploma/Degree
Majority of education was earned outside the U.S. *

Yes No
Degree or Diploma was earned outside the U.S.

Yes No
Labor Force Status *

Unemployed Employed Employed with notice Not employed/not seeking work
Barriers to Employment-Mark all that apply *

Cultural Barriers Disabled Displaced Homemaker English Language Learner Ex-Offender Foster Care Youth Homeless Long-term Unemployed Low income Low Levels of Literacy Migrant & Seasonal Farmworker Seasonal Farmworker Single Parent No TANF in 2 Years or Less
Primary Goal-Mark one only *

Improve basic skills Improve English skills H.S. Dipl./HSE Get a Job Retain Job Get a better job Enter college or training Work-based project Family Goal Military Personal Goal Enter short-term training Get off TANF or other Public Assistance None
Secondary Goal-Mark all that apply *

Improve basic skills Improve English skills H.S. Dipl./HSE Get a Job Retain Job Get a better job Enter college or training Work-based project Family Goal Military Person Goal Enter short-term training Get off TANF or other Public Assistance None
Do you have any misdemeanor arrests or convictions? *

No Unsure Yes
If yes, please explain
Have you been convicted of a felony? *

No Unsure Yes
If yes, please explain
Are you under any court orders? *

No Unsure Yes
If yes, please explain
How did you hear about our program *

Friend/Family Flyers Internet Search Special Programs (IowaWorks, Promise Jobs, etc) Other
FERPA Consent

I understand that the records to be disclosed include my social security number and other personally identifiable information from my education records. I acknowledge that the purpose of the disclosure is to assist the Iowa Department of Education in obtaining and reporting information concerning the placement and retention of participants in employment as required by section 212 of Title II of the Workforce Innovation and Opportunity Act (WIOA). I understand that the personally identifiable information will be disclosed by the educational institution to other WIOA partners (including but not limited to Iowa Workforce Development, Iowa Vocational Rehabilitation Services, and the Iowa Department for the Blind) and the National Student Clearinghouse. This information may not be re-disclosed to others and will be destroyed as soon as all statistical analysis has been performed, or when the information is no longer needed, whichever date comes first.
*

I, as a participant at a postsecondary educational institution or age 18 years orolder, consent to the release of personally identifiable information from myeducation records; or I, parent or guardian of a participant at a secondaryeducational institution under the age of 18, consent to the release ofpersonally identifiable information from the education records of myson/daughter.
Type your full name to electronically sign your FERPA release(s) *
Date/Time
Release of Information to Employer or Family

Southwestern Community College requires a signed Release of information form on file to share information regarding your educational plan, status, and outcomes with applicable individual(s) and/or organization(s). This may including but not be limited to: transcripts, atendance, academic achievements and test results. This form must be signed in person and will be available at orientation.

https://drive.google.com/file/d/1lnCnKsWbPNMVn8HE9m-0p_nwZoKqoaAc/view?usp=sharing
Age Restrictions
- Students who are 16 are not permitted to test by law
- Students who are within three months of their 17th birthday will be permitted to enroll but must wait to test until on or after their 17th birthday.
- Graduates will not receive a diploma until they have reached 18 years of age and/or the applicant's class from ninth grade has graduated.
Request for Admission to Test Age Waiver form- Required for 16, 17 and some 18 year olds
- This form must be completed, signed, and dated by a legal parent or guardian and presented at orientation for students under the age of 18.
- Verification of nonenrolled status from the last high school attended is required for an applicant under 19 years of age.
https://drive.google.com/file/d/1bjSYebEElTF9WM-zEkBNuZ9ouJneeHjM/view?usp=sharing
Cost

There is no fee for material, instruction, technology access or pre-assessments. HiSET scholarships are available for those who qualify. Please ask your instructor for details.

Orientation

Orientation is required for all new and returning students who have been inactive for more than one year. Your orientation can be scheduled after you complete this form.
*

I understand that my next step is to schedule my orientation based on the calendar for my location.
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High School Equivalency & English as a Second Language Programs Registration Form