ESL/Adult Lit/HSE Registration & Inquiry Form

Coastal Alabama | Adult Education

English Language Acquisition, Adult Literacy, and High School Equivalency No Cost Programs Registration & Inquiry Form
*If you have earned your GED or High School Diploma and want to register for our College and Career Essentials class, please use this link instead:

https://form.jotform.com/230167421312140
Student Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student E-mail - We will contact you at this email.*
example@example.com
Phone Number - We will contact you at this number.*

Area CodePhone Number
Are you currently employed?*
Last school or program type attended:*
Highest level of education?*
Name of last school or program attended:*
Number of credits earned from any school or program attended:*
*If unsure, you can type "UNKNOWN" in box.
Have you ever been enrolled with an Adult Education program in Alabama? If NO, please type NO. If YES, please note where.
Select the class and location you would like to enroll in or want more information on.*
If you would like to register/inquire about more than one program, please fill out a new form for each program.
How would you like to be contacted?

EmailPhoneText
Last Question: How did you hear about us?

Another studentMy high schoolCoastal Alabama websiteOne Part Left! Campaign - EmailOne Part Left! Campaign - Snail MailTV advertisementAdult Ed Tri-Fold PamphletOther
Should be Empty:

Coastal Alabama | Adult Education