Adult Learner Registration (ABE/ELL)

Adult Learner Registration

Please fill out the following form in order to start the process of enrolling in classes with Washington Township Adult Education. Allow 72 hours for a member of our staff to reach out to you.
What program at Washington Township Adult Education are you interested in enrolling in? *

English Classes (for non-native English Speakers) High School Equivalency
Name *

First Name Last Name
Social Security Number or ITTN *
(If no SSN, fill in all ones.)
Has COVID-19 resulted in any of the following in your life: *

Unemployment Reduced hours at work Change in childcare Working from home Filed for unemployment Myself or someone I know was infected with COVID-19 My children do e-learning at home now My usual fitness routine has changed Reduced/limited contact with family Other None of these
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
County of residence *
i.e. Marion County
Phone Number *
Please enter a valid phone number.
Email *
example@example.com
Date of Birth *

Month Day Year
Date
Gender *

Female Male Nonbinary Prefer not to say
Ethnicity *

Hispanic Other
Race *

American Indian African American Asian Pacific Islander White Other
Native Country *
Are you a US Citizen? *

Yes No Currently in application process Other
If you are not a US citizen, do you have a work permit? *

Yes No Working on it Other
Are you currently employed? *

Yes No
Where do you work? *
What is the highest level of schooling you received? *

Grades 1-5 Grades 6-8 Grades 9-12 NO DIPLOMA Certificate of Completion (Disability/IEP) High School Equivalency High School Diploma Some Post-secondary (NO DEGREE) Certification or other non-degree technical program Bachelor's Degree Associate's Degree Master's/PhD Other
Name of the last school you attended: *
Example University
Was the last school you attended in the US? *

Yes No
Are you currently enrolled in school? *

Yes No
If yes, what is the name of your current school? *
Do you claim any dependents? *

Yes No
How many dependents do you claim? *

0 1 2 3 4 5 6 Other
What is your household size? *
i.e. 3
What is your annual household income? *
Have you previously been a student at Washington Township Adult Education? *

Yes No
How did you find out about Washington Township Adult Education? *
Select any of the following demographics that apply to you: *

Veteran Disability (Physical/Mental) Live in an urban area (in the city) Live in a rural area (outside of the city) HIPP/SNAP Recipient Low Income Stay-at-home parent/guardian/caretaker Single Parent Currently laid off or terminated Claims Dependents Foster Care Homeless Non-English used at home Active Military (or military spouse) Vocational Rehabilitation Wagner-Peyser Employment Migrant/Seasonal Farmworker Ex-Offender Cultural Barriers to Employment
I am enrolling in an adult basic education (ABE) program. This ABE program works with the following programs and agencies to help students improve their skills and earn better jobs: other state-funded adult education programs; WorkOne offices and job training programs; public and private colleges; state executive offices, departments, and agencies (including the Indiana Department of Workforce Development); and the division of Adult Education and the Indiana Department of Education. By signing this form, I understand and agree to the following: DWD use of directory information (name, address, birth, and social security number) to match test score records, wage information, and college/training program enrollment records that assist the state to evaluate and improve its programs and to report results to the federal and state government and the sharing of information between the agencies and programs listed above. This information may include my name, enrollment information, education/career goals, test scores, and employment history. The information will be kept strictly confidential and will be used for program administration, research, and evaluation purposes. By filing in your full name below you are agreeing to these terms. Please type your name and date below. Students under the age of 18 must have this consent form signed by the student’s parent or guardian. *
Name
I give WTAE permission to share photo images and student approved testimonials on WTAE social media platforms, website, and partnering state agencies. *

Yes No
There is a $20 non-refundable registration fee that you must pay before starting classes. How would you like to pay? *

Cash Check Credit/Debit Other
Should be Empty: