HSE Student Application
Fill out the form carefully for registration. We will follow up as soon as possible.
Before beginning the application, please read the following statements. CHECK all of the statements that apply to you.
*
I can commit to meeting with a tutor 1-2 times per week for 45-90 minutes at a time
I can commit to doing homework and having it ready for each tutoring session
I am eager to earn my HSE diploma and am pursuing this degree on my own accord
If any of the boxes above are unchecked, please let us know what barriers may be in the way:
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Month-Day-Year
Mobile Phone Number
*
Please enter a valid phone number.
E-mail Address
*
example@example.com
Mailing Address
*
Street Address
Street Address Line 2/Apartment #
City
State / Province
Postal / Zip Code
What is your primary language?
*
English
Spanish
Portuguese
French
Arabic
Haitian Creole
Other
What are your preferred pronouns?
*
He/Him/His
She/Her/Hers
They/Them/Theirs
Other
What is your availability for tutoring sessions?
*
Weekdays Morning Zoom
Weekdays Morning In Person at Beverly Bootstraps
Weekdays Afternoon Zoom
Weekdays Afternoon In Person at Beverly Bootstraps
Weekdays Evening Zoom
Weekends
When were you last enrolled in school?
*
What is the last grade of school that you completed?
*
Grades 6-8
Grades 9-12
What is the name of the last school you attended (School Name/City/State/Country)?
*
Were you receiving Special Education accommodations?
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Yes
No
If yes, do you have an IEP or educational testing reports to share?
The MA Department of Education Requires that each test taker present a valid, government-issued ID that shows your name in the English alphabet, your signature and your photograph. Do you have such identification?
*
Please briefly explain why you are interested in the HSE program at Beverly Bootstraps:
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How did you hear about Beverly Bootstraps Adult Education programs?
*
Website
Flyer
Newspaper
Friend
Other
All of the information I have provided in the above application is true. I understand that just by completing this form, does not mean that I am accepted as a student.
*
I agree
I do not agree
Submit
Should be Empty: