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Torrance Adult School - Student Enrollment Information: Earned Outside The U.S

This document contains a student enrollment form for Torrance Adult School that collects information such as the student's name, address, date of birth, ethnicity, educational background, employment status, goals for attending school, barriers to employment, emergency contact details, and agreements regarding photo release and sharing of student information. The form is used to enroll students at Torrance Adult School and gather key details about their demographics, education and employment history, needs, and consents.

Uploaded by

Oscar Yesid Pinzon Ramirez
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© © All Rights Reserved
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130 views1 page

Torrance Adult School - Student Enrollment Information: Earned Outside The U.S

This document contains a student enrollment form for Torrance Adult School that collects information such as the student's name, address, date of birth, ethnicity, educational background, employment status, goals for attending school, barriers to employment, emergency contact details, and agreements regarding photo release and sharing of student information. The form is used to enroll students at Torrance Adult School and gather key details about their demographics, education and employment history, needs, and consents.

Uploaded by

Oscar Yesid Pinzon Ramirez
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Student ID # I attended Torrance Adult School before: ☐ Yes ☐ No

Torrance Adult School - Student Enrollment Information

Sex: ☐ Male ☐ Female ☐ Other


Last Name (Print) First Name (Print) MI
Address:
Number Street Apt#
City: Zip: Birth Date - - Ph: ( ) -
Month Day Year ☐ Home ☐ Wk ☐ Cell
Email:
Are you Hispanic or Latino? ☐ Yes ☐ No
Ethnicity/Race: (Mark one or more):
☐ White ☐ Asian ☐ Black ☐Filipino ☐ American Indian ☐ Pacific Islander/Hawaiian ☐ Alaska Native
Native Language:
☐ English ☐ Spanish ☐ Vietnamese ☐ Chinese ☐ Hmong ☐ Cambodian
☐ Tagalog ☐ Korean ☐ Lao ☐ Russian ☐ Farsi ☐ Other
Circle highest year of school you completed: Elementary: 0 1 2 3 4 5 6 7 8 Secondary: 9 10 11 12 Post-Secondary: 13 14 15 16 +
☐ Earned outside the U. S.

What is your highest educational level? ☐ 2 Yr College Degree (AA) Employment Status
☐ None ☐ Technical Certificate ☐ Employed
☐ HSE Certificate (HiSet, GED, TASC) ☐ 4Yr College Graduate ☐ Unemployed
☐ High School Diploma ☐ Graduate Studies ☐ Not employed and not seeking work
☐ Some College (No degree) ☐ Earned outside the U.S. ☐ Retired

Section # 1 Course Title Pmt. Amt.

Section # 2 Course Title Pmt. Amt.

What are your goals for this school year?


Mark all that apply Barriers to Employment Mark ALL that Apply
☐ Improve basic literacy skills ☐ Cultural Barriers ☐ Long-term Unemployed
☐ Improve English skills ☐ Disabled ☐ Low Income - Below $15,782
☐ H.S. Diploma/HSE Type: Add $5,616 for each additional family member
☐ Get a job ☐ Displaced Homemaker ☐ Low Literacy / Math
☐ Retain a job ☐ English Language Learner ☐ Migrant Farmworker
☐ Enter college or training ☐ Ex-Offender ☐ Single Parent
☐ Work-based project ☐ Foster Care Youth ☐ Seasonal Farmworker
☐ Family goal ☐ Homeless ☐ Other Barriers:
☐ U.S. Citizenship
☐ Military Status / Public Assistance Mark ALL that Apply
☐ Personal goal ☐ Dislocated Worker ☐ SSI
☐ Other ☐ Food Stamps / Cal Fresh / SNAP ☐ U.S. Veteran
☐ Get a better job ☐ Free and Reduce Lunch ☐ WIOA: ☐ l ☐ lll ☐ lV
☐ Enter short-term training ☐ No TANF - CalWORKs within 2 years. ☐ Other Public Assistance
☐ Get off TANF or other Public Assistance ☐ TANF - CalWORKs ☐ None of the Above
All students must mark this area: Grants & Financial Assistance
☐ Limited English Proficiency (LEP) ☐ BOGG (Board of Governor's Grant) ☐ General Assistance (GA)
☐ Economically Disadvantaged/Low Income ☐ Bureau of Indian Affairs ☐ Pell Grant
☐ Medi-Cal ☐ CalWORKs
Emergency Contact Information
Contact Name: Relationship: Contact Phone:
☐ Home ☐ Wk ☐ Cell
By signing this form, I agree to the Internet Agreement on the TAS website under the Terms of Use and the photo Release Agreement in the Catalog.
*If you do not agree to the Photo Release agreement, please submit a letter to the Torrance Adult School Administrator.
By signing this form, I allow my school information to be shared with other educational/career institutions.

Student Signature: Date:


Rev 10/16/18 Entered by: Date:

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