• Adult Learners Registration

    Adult Learners Registration

    Lawrence Education and Community Center

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    Please complete the following form in order to begin the enrollment process to attend our English and GED classes at our Education and Community Center in Lawrence Township.  Upon completion, you will receive an auto confirmation email.  If you do not see the email, please check your JUNK email folder before completing an addition registration.

    *You can translate this form into your native language when you open in Google Chrome and click the Google Translate Extension in your browser.

  • Date*
     / /
    2 digit month, 2 digit day, 4 digit year
  • I am registering for Classes, please select one:*

  • Student Information

  • Are you a U.S. Citizen?*
  • Format: 000-000-0000.

  • Emergency Contact Information:

  • Format: 000-000-0000.

  • Demographics

  • Date of Birth: (mm/dd/yyyy)*
     / /
    2 digit month, 2 digit day, 4 digit year

  • *ATTENTION MINORS: If student is 16 or 17 years old, the state of Indiana requires an Exit Form be completed by the High School you last attended in order to enroll in an Adult Education program. A link to the Exit form can be found under the Adult Basic Ed Classes FAQ section on our website, indyadulted.com.

  • Gender:*
  • Ethnicity: (select one)*
  • Race: (check all that apply)*

  • Employment

  • Employment Status:*
  • If not a U.S. Citizen, do you have a work permit?*

  • Education Information

  • Current Education Status:*
  • Last school attended was:*
  • What is the highest level of education completed? (select one)*
  • Have you ever taken Adult Education classes?*
  • Did you have an IEP or ever receive test accommodations?*

  • Other Demographics

  • Check all of the following demographics that apply to you:

  • Release of Information Form

    Release of Information Form

  • am enrolled in an adult basic education program. This program works with the following organizations 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 (DWD), Division of Adult Education and the Indiana Department of Education
    • The organization affiliated with your classroom (including community centers, libraries, faith organizations, school districts, etc)

    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
    • 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.
  • Date*
     / /
    2 digit month, 2 digit day, 4 digit year

  • *Students under the age of 18 must have this consent form signed by the student’s parent or guardian.

  • I give WTAE permission to share photo images and student approved testimonials on WTAE social media platforms, website, and partnering state agencies.*

  • Should be Empty: