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Application For Classes (GED, Parenting, Life Skills) 400 N PINE HILLS RD SUITE 190 ORLANDO FL 32811 407-440-2383
www.trtcenter.org
Name
*
First Name
Middle Name
Last Name
Maiden Name
Today's Date
*
/
Month
/
Day
Year
Date
Student Email
*
example@example.com
Date of Birth
*
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Alternate Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Gender
*
Race (Select all that apply)
*
American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian or Pacific Islander
White
Hispanic or Latino?
*
Yes
No
Highest School Grade Completed
*
None
Completed at least part of 1st through 11th grade
Completed the 12th grade, but did not attain a diploma or equivalency
Earned a high school diploma
Have a disability and attained a special diploma ot high schoo; certificate of attendance/completion from completing an Individual Education Plan (IEP)
Completed some college, but did not earn a certificate or degree
Earned a Career Certificate
Earned an Associate of Applied Sciences degree
Earned an Associate of Science degree
Earned an Associate of Arts degree
Earned a Bachelor's degree
Attained beyond a Bachelor's degree
If you selected "Completed at least part of 1st through 11th grade," what is the highest grade level you completed?
This level of education was achieved in
*
A U.S. based school
A non-U.S. based school
Employment Status
*
Employed
Employed but with Notice of Termination or in transition out of military service
Not employed (looking and eligible for employment)
Not in labor force (incarcerated, not eligible for employment, or not seeking employment)
Citizenship (For State Reporting Purposes)
*
Non-Resident Alien
U.S. Citizen
Permanent Resident Alien
Background (Select all that apply)
*
Youth in Foster Care (including aged-out)
Single Parent
Single Pregnant Person
Perceived employment barriers
Perviously or currently subject to any stage of the criminal justice process
Low-income individual (or their dependant) employed primarily in farming currently unemployed or finding difficulty obtaining for for 12 months out of the last two years
Migrant or seasonal farmworker (or their dependant)
Homeless without a fixed, regular nighttime residence
Homeless but staying in non-traditional housing (ex. park, abandoned building, bus station)
Child of migrants who have changed school districts in the last 3 years due to parents' seasonal employment
Previously unemployed or underemployed while caring for home and family (unpaid)
Previously supported by public assistance or family, and now unemployed or underemployed
Parent of a child within two years of no longer receiving TANF (formerly AFDC)
Unemployed dependent spouse of a member of the Armed Forces on active duty or is deceased or disabled as a result of military service
Income Status
*
Student currently eligible to recieve Temporary Assistance for Needy Families (TANF) under Part A Title IV of the Social Security Act, however the student's eligibility will be exhausted within two years of current reporting year
Student has been unemployed for 27 weeks or more at the time of entry in the current reporting year
Student self-identifies as having low income at the time of entry in the current reporting year under any of the following: Student or immediate family recieve benefits under Supplemental Nutritional Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF), Supplemental Security Income (SSI), or other state public assistance; Total family income does not exceed higher than the poverty line or 70% of the lower living standard income level; Student is current in a foster program; Student has a disability and has personal income at or below the poverty line, regarding of family income; Student is a youth living in a high-poverty area
Military Status (For State Reporting Purposes)
*
Active-Duty Personnel
Eligible Dependant (spouse/child)
Veteran (Prior service, Service dates unknown)
Veteran (Prior service, service on or after 9/11)
Veteran (Prior service, service prior to 9/11)
Active Member of the Reserves
Active Member of the National Guard
No Military History
My Products
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GED Program Registration Fee
$25.00
$
25.00
Quantity
1
Parenting Classes Registration Fee
$25.00
$
25.00
Quantity
1
2
3
4
5
6
7
8
9
10
Life Skills Classes Registration Fee
$25.00
$
25.00
Quantity
1
2
3
4
5
6
7
8
9
10
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
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Expiration Month
Expiration Year
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