2023 Registration Form for LACES

Before you proceed, were you directed to this page by a Project Learn staff member? If so, please continue. If you are interested in signing up for classes, please go to projectlearnsummit.org and click Get Started. This form does not schedule you to start class.

Project Learn of Summit County Secure Online Registration Form

Please complete the form. If you have any questions, please ask your facilitator.
Student Information
Today's Date*

MonthDayYear
Date
Name*

First NameLast Name
Middle Initial
Other names
Gender*
Date of Birth*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County*
Cell/Mobile Phone*
Please enter a valid phone number.
Home Phone
Please enter a valid phone number.
Email*
example@example.com
What country were you born in?*
Are you registered to vote?*
Preferred method of contact*
Emergency Contact Person*
Emergency contact phone*
Please enter a valid phone number.

Student Information Continued
Household yearly income*
Do you have any allergies we should know about?*
If yes, please explain
Do you have any medical conditions we should know about?*
If yes, please briefly explain.

Are you an Immigrant or Refugee?*

Yes, I am an Immigrant.Yes, I am a Refugee.No, I am not an Immigrant or Refugee.
What reason(s) do you want to improve your English Language skills?*

Achieve Citizenship SkillsVote or Register to VoteIncrease Involvement in Community Activities
Do you have an F-1 Visa (An F-1 Visa allows citizen of other countries to live in the United States temporarily to study at a university or college.)*

YesNo

Student Demographics
Are you Hispanic/Latino?*

YesNo
Please check all that apply to you*

American Indian or Alaskan NativeAsianBlack or African AmericanNative Hawaiian/ Pacific IslanderWhite

Student Work and Education Status
Work Status*
Are you registered on OhioMeansJobs?*

YesNoI don't know
What is your highest level of school completed? *
Where was the last school you attended?*

STATE OF OHIO RELEASE OF INFORMATION
I authorize the Chancellor of the Ohio Department of Higher Education to release my educational records, which includes my name, social security number, student ID number, and date of birth, to the agencies listed below. The agency use of these records is limited to and in connection with the audit and evaluation of Federally supported education programs, or in connection with the enforcement of the Federal legal requirements, that relate to such programs.
Student/Examinee information released for the purpose of:

Aspire Enrollment: Student records may be shared with another Aspire program if the student is attending multiple Aspire programs or leaves one program to seek Aspire services through another local provider.

Employment: Ohio Department of Job and Family Services, 30 East Broad Street, 32nd Floor Columbus, Ohio 43215

High School Equivalence Diploma: Ohio Department of Education 25 S. Front Street Columbus, Ohio 43215

Co-Enrolled Educational Outcomes: Opportunities for Ohioans with Disabilities 400 East Campus View Blvd. Columbus, Ohio 43235

My signature is acknowledgement that have read and voluntarily consented (or declined) to the release of the above- mentioned educational records as collected and utilized by the Aspire program have previously enrolled in or tested with. Students under the age of 18 must have this form signed by a parent or guardian.
Release of Information Accept/Decline

AcceptDecline
By typing my name in this box, I agree that this is the electronic representation of my signature.

Project Learn of Summit County Code of Conduct
The purpose of the Code of Conduct is to provide a safe and comfortable learning environment for all students, staff and volunteers.

General Guidelines
- Adhere to all guidelines, rules, and procedures of the building in which you attend classes or tutoring.
- Personal devices must be silenced. If you need to take a call, please excuse yourself from the classroom.
- Students are responsible for cleaning up after themselves.
- Be respectful of the learning environment. We strive for a positive learning experience for all. Any person who is being disruptive or inappropriate will be asked to leave, and may be dismissed from the program permanently.
- Be on time and attend every class. If you are going to be late or absent, contact your instructor and/or Project Learn. Seats are not guaranteed for students who do not attend 75% of scheduled classes.
- Students are responsible for providing their own transportation. Requests for personal favors, money, or rides are not permitted.
- Computer use is limited to activities associated with class or tutoring. There are computers located in the library for personal use.
- No children or visitors are permitted in classes or during tutoring sessions.
- Use, possession or being under the influence of drugs or alcohol on the premises will result in immediate dismissal from the program.
- Use or possession of any type of weapon on the premises will result in immediate dismissal from the program.
- Sexual harassment will result in immediate dismissal from the program. Sexual harassment includes unwelcome sexual advance, requests for sexual favors, and other verbal, visual, or physical conduct of a sexual nature.
- Physical/verbal aggression or threatening behavior will result in immediate dismissal from the program. This also includes hindering, impeding, or preventing free movement of any individual.
- Destruction or misuse of any property belonging to Project Learn, the building where classes or tutoring is held, or any person on said premises will result in immediate dismissal from the program.
- Any illegal act will result in immediate dismissal from the program.
I have read, understand and agree to follow all the rules and guidelines stated in Project Learn's Student Code of Conduct. I also understand Project Learn's attendance policy. I realize that failure to comply with the stated guidelines may result in my dismissal from the program.
By typing my name in this box, I agree that this is the electronic representation of my signature.

Project Learn of Summit County Media Consent Form
I give/do not give Project Learn of Summit County permission to use my images or personal information of social media - examples include but are not limited to Facebook, Instagram, Twitter, and the Project Learn of Summit County website, marketing materials, videos and/or photos.*

Give permissionDo NOT give permission
By typing my name in this box, I agree that this is the electronic representation of my signature.
Should be Empty:

Before you proceed, were you directed to this page by a Project Learn staff member? If so, please continue. If you are interested in signing up for classes, please go to projectlearnsummit.org and click Get Started. This form does not schedule you to start class.

Project Learn of Summit County Secure Online Registration Form

Student Information

Student Information Continued

Student Demographics

Student Work and Education Status

Other information

Reasons for joining Project Learn

STATE OF OHIO RELEASE OF INFORMATION

Project Learn of Summit County Code of Conduct

Project Learn of Summit County Media Consent Form