Pre-Registration and Inquiry Form
Please fill in the form below. After submitting, one of our staff will contact you shortly! Do not fill out this form if you already have an appointment to enroll.
Full Name
*
First Name
Middle Name
Last Name
Date of Birth (mm/dd/yyyy)
*
/
Month
/
Day
Year
Date
Gender
Male
Female
Other
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Phone Number
*
-
Area Code
Phone Number
E-mail
*
Preferred Contact Method
Phone Call
Text
Best Time of Day to be Contacted
Morning (8am-noon)
Afternoon (1pm-4pm)
Evening (5pm-9pm)
Any time
What classes are you interested in?
*
GED
High School Diploma
English as a Second Language
Work Keys Testing Only
Other Academic or Career Coaching Assistance
Which of our locations is closest to your residence or would you prefer attending class at? *Not all classes are offered at all locations.
*
Please Select
Cedar Springs
Comstock Park
Grand Rapids NW Side
Kentwood
Sparta
Uncertain
How did you hear about our program?
Flyer
Facebook
School Office
Friend/Family
Other
Submit Form
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