2022-2023 Adult Learner Registration (ABE)

Adult Learner Registration

REGISTRATION IS NOW OPEN FOR OUR 2022-2023 SCHOOL YEAR. Our next session will begin classes the week of July 11th at most of our sites (Noblesville locations start August 8th & Pike location starts August 15th). Please complete the following form in order to begin the process of enrolling with Washington Township Adult Education. Upon completion of your Registration, you will receive a confirmation email. If you do not see the email, please check your SPAM email folder before completing an additional registration. After you submit your registration, please call 317-259-5275 and ask for Gretchen or Amy to schedule your intake and testing.
What program at Washington Township Adult Education are you interested in enrolling in? If you want English classes, this is NOT the correct registration. Our English classes are full. Please check back in October. *

HSE Prep Classes
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 *
Are you a citizen of the United States? *
Native Country *
What is your Native Language? *
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
Student's Phone Number *
Please enter a valid phone number.
Emergency Contact Name *

First Name Last Name
What is your relationship to your emergency contact
Emergency Contact Phone Number *
Please enter a valid phone number.
Student's Email *

Confirmation Email example@example.com
What is your Date of Birth? *

Month Day Year
Date
Are you over 18 years old? *

Yes No
If you are 16 or 17 years old please print this Exit Form and have it completed by the High School you last attended. An Exit Form is required by the state for minors to enroll in Adult Education programs.
Gender *

Female Male Nonbinary Prefer not to say
Ethnicity *

Hispanic Other
Race *

American Indian African American Asian Pacific Islander White Other
Are you currently employed? *

Yes No (Unemployed, looking for work) Not in the labor force Other
When did you start working at your job? *

Month Day Year
Date
Where do you work? *
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
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
Are you currently enrolled in school? *

Yes No
If yes, what is the name of your current school? *
Was the last school you attended in the US? *

Yes No
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 Displaced Homemaker 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
Do you have any dependents (children under 18) or are you a dependent (under 18)? *

Yes No
What is your annual household income? *
How many people are in your household? *
i.e. 3
Have you previously been a student at Washington Township Adult Education? *

Yes No
How did you find out about Washington Township Adult Education?j *
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. *
Signature of Student OR Parent/ Guardian if a minor
I give WTAE permission to share photo images and student approved testimonials on WTAE social media platforms, website, and partnering state agencies. *

Yes No