Language
English (US)
Spanish (Latin America)
Arabic
French (France)
English Class 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. If you need help filling out this form, we can help you when you come in person to orientation or over the phone. You can translate this form into your native language using the button in the upper right.
What program at Washington Township Adult Education are you interested in enrolling in?
*
English Classes (for non-native English Speakers)
Name
*
First Name
Last Name
Social Security Number or ITTN
(If no SSN, fill in all ones.)
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.
Your Email
*
example@example.com
Your Date of Birth
*
-
Month
-
Day
Year
Date
Emergency Contact Phone Number
*
Please enter a valid phone number.
Emergency Contact Name
*
First Name
Last Name
Are you under 18 years old?
*
Yes
No
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
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
When did you come to the United States?
-
Month
-
Day
Year
Date
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
Not in the labor force
Other
If you are not in the labor force, what best describes your situation?
I am not eligible for work in the USA
I am retired
I am a homemaker
I am disabled
Other
Where do you work?
What is your job title?
Do you work full-time or part-time?
Full-time
Part-time
When did you start working at your job?
-
Month
-
Day
Year
Date
What is your current school attendance status?
In high school
In college
Not in school
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
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 have any dependents (children under 18) or are you a dependent (under 18)?
Yes
No
What is your household size, including yourself?
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 or within 50 miles of it)
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 on the day of your in-person intake. How would you like to pay?
Cash
Check
Credit/Debit
Other
Please select a date below that you are interested in for attending orientation:
April 16, 2021 @9:45am
April 21, 2021 @5:30pm
Submit
Should be Empty: