AES Literacy Institute New Student Application

AES Literacy Institute Student Application

Interested in earning your High School Equivalency Diploma? Fill out our student application below. Be sure to like and follow us on social media to stay up to date with all the latest information. We look forward to helping you graduate!
**Please Note** This application places you on a wait list for our next upcoming free cohort. Completing this application does NOT guarantee you a seat in the next course. If you are looking to earn your equivalency diploma immediately; please consider purchasing Diploma In A Box.

*At this time our free program is limited to students under the age of 26. If you are over the age of 26, please visit our website for information about how to purchase your Diploma In A Box.
Student Background Information
Name*

First NameMiddle NameLast NameSuffix
Date of Birth*

MonthDayYear
Age*
Must be under the age of 26
Best Contact Number*

Area CodePhone Number
E-mail Address*

Confirmation Email
Please verify that the email you entered is correct and that you have access to it*

YesNo
Are you a US Citizen:*

YesNo
Ethnicity:*

Hispanic/LatinoNot Hispanic/Latino
Gender*

FemaleMaleN/A
Race (check all that apply)*

American IndianAsianBlack/African AmericanNative Hawaiian/Other PacificWhiteAlaska Native
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Do you have a valid ID or Drivers License?*

YesNo
Household & Income Information

Please complete to help us understand your current household and income
Please describe your current household annual income*

Under $20k$21k - 30k$31k - $40k$41k - $50k$51k - $60kOver $60k
Please select one*

SingleMarriedSeparatedDivorcedWidow
Current Household Size (including yourself)*
Ex. You, Spouse,2 kids = 4
How many children, if any, are in your household under the age of 17?*
If None enter 0
Do any of the following apply to you? (select all that apply)*

minority individualmigrant seasonal farmworkerdislocated workerdisabledsingle parentveteranprobation/paroleSSIFood stamps/WIC/TANFhomelessnone of the above
Previous Educational Experience

Please describe your previous high school and any previous adult literacy program experience you may have.
Did you attend high school? If so, where? *
Ex. Spruce High School
Highest Grade Completed? *
What year were you suppose to graduate*
Ex: 2018
Number of years you have been out of school?*
Ex. 3
Have you attended an adult education / HSE prep program before?*

YesNo
If yes, what previous adult program did you attend and when? (if none enter N/A)*
Ex. Adult Ed 2015
How long have you been ACTIVELY trying to obtain your equivalency diploma?*

First Time3-5 Years0-2 Years6-9 Years9+ Years
What do you feel is your WEAKEST subject? (check all that apply)*

ReadingWritingMathematicsScienceSocial Studies
What do you feel is your STRONGEST subject? (check all that apply)*

ReadingWritingMathematicsScienceSocial Studies
Current Student Technology

You are required to have a desktop, laptop, or tablet with a reliable internet connection in order to participate in our remote learning program. Please answer the question below to help us understand your technology needs.
Have you taken an online class before?*
Do you have a working desktop, laptop, or tablet to study remotely?*
Do you have an active internet connection at home?*
Do you have a quiet, distraction free place to study?*
Can you commit to 1 hour or more of study per day?*
How many hours can you dedicate to studying per week? *
Do you have a working webcam/camera and microphone to participate in online academic advisement sessions and conferences*
How well is your ability to navigate the internet and access online class materials, emails, logins, etc. to complete study remotely?*
Please Complete the Following Questions

Please answer the following questions in as much detail as possible to help us better understand your adult literacy program needs.
What stopped you from graduating from traditional high school? *

0/1000
Why is getting your High School Equivalency Diploma important to you?*

0/1000
Do you suffer from financial difficultly? If yes, please explain*

0/1000
What are your plans/goals after you graduate?*

0/1000
What things will make it difficult and/or may distract you from obtaining your educational and career goals?*

0/1000
Current Employment Status

Please complete this session to help us better understand your current and future employment status and goals.
Are you currently employed?*

YesNo
If you are NOT currently employed, are you actively seeking employment?*

YesNoN/A
If you are currently employed, where do you work? (if unemployed type N/A)*
Ex. Walmart, Kohls, Target
How much do you currently earn (or previously earned) while working?*
Ex. 9/h or 12 per hour
Upon graduating will you change and/or upgrade employment?(check all that apply)*

find new employementchange employmentupgrade employment (promotion)
Personal, Educational, and Career Goals
How soon are you looking to earn your high school equivalency diploma?*
Educational and career short term goals 1year or less (check all that apply)*

Enroll in collegeGet a new jobEnroll in a trade/technical collegeRetain job or advance jobEnter the militaryOther
What are your long term career goals? (2-5 years)

0/250
Any additional information that you would like us to know?

0/500
How did you find us?*

FacebookInstagramGooglePersonal ReferralOther
If personal referral, who can we thank for referring you to our program?
Ex. Joe Smith, TWC, etc.
Terms and Conditions

Please review the terms and conditions below.
The information provided is complete and correct to the best of my knowledge. I agree to abide by AES Literacy Institute policies, rules and regulations. I further understand the submission of false information is grounds for rejection of my application, withdrawal of acceptance, and cancellation of enrollment. My signature below shall constitute acknowledgement to statistical use of my records of enrollment, progress, and transition under the application laws, state regulations and AES Literacy Institute internal policies as aggregate statistical data in evaluation of the program, and shall constitute a precondition for enrollment in this adult education and literacy program. I acknowledge that the AES Literacy Institute will release information to other state and federal agencies for verification, follow-up, and tracking and to generate reports to monitor the program. I give my consent for release of directory information, photo/video, which consists of name, address, telephone number, date of birth, dates of attendance, degrees obtained, and field of study. Participants who are 17 years of age must have written permission to participate in the program.
Please Authorize Consent To Continue*

I Agree
Today's Date

MonthDayYear
Date
By clicking submit entry you verify the information provided above is complete and accurate to the best of your knowledge. Your application will be submitted for review by our enrollment department.*

I Agree

AES Literacy Institute Student Application

Student Background Information

Household & Income Information

Previous Educational Experience

Current Student Technology

Please Complete the Following Questions

Current Employment Status

Personal, Educational, and Career Goals

Terms and Conditions