Adult Education Registration Screening Form

Adult Education Registration Screening Form
Name*

First NameMiddle NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
What is your citizenship status?*

U.S. CitizenLegal ResidentLawfully PresentNone of the above
Alert: You are unable to receive our services.
Which county do you live in?*

CoconinoNavajoOther
Do you have a valid government photo I.D.?*

YesNo
Alert: You must obtain a government photo I.D. in order to register.
Are you 16 or older? *

YesNo
Alert: You are unable to receive our services.
- If you are 16 or 17, you will be required to provide a withdrawal form from the last school you were enrolled in and a notarized parental permission form.
- View GED Parental Permission Form.
What area are you interested in?*

High School EquivalencyEnglish as a Second LanguageWorkforce Training/Employment
GED/High School Equivalency Program Information:
Services Provided:
- Free non-credit preparation classes for the GED exam
- Classes are offered in the morning and evening, in-person and on Zoom
- Optional arrangements are available for independent, online courses
- Payment vouchers are provided for the GED Ready Practice Tests
- Individual success coaching
- Tutoring services
- Access to college and community resources
- Opportunities for workforce training
Expectations:
- Minimum of 8 hours of class/academic work per week
- Minimum of 40 hours total attendance per semester
- Active participation in class
- Complete required placement and progress testing
- Attend all scheduled appointments and classes
- Active communication with instructors/staff
- Access to a desktop or laptop computer is needed; a smartphone or tablet does not meet program requirements.
* Failure to meet these expectations will result in separation from the program.

* Important to Note:
- GED exams are administered at the NAU Testing Center or the CCC Page Center
- We do not cover the costs for the GED exams; outside assistance may be available
If you have additional questions, please contact the Adult Education Program Assistant:

Linda Fullerton
928-526-7639
Linda.Fullerton@coconino.edu
English as Second Language Program Information:
Services Provided:
- Free non-credit classes in English (Beginner, Intermediate, Advanced)
- Classes are offered in-person, in the afternoon and evening
- Arrangements may be made for attending on Zoom
- Supplemental study may be provided in an independent, online program
- Tutoring services may be provided
- Access to college and community resources
- Opportunities for workforce training
Expectations:
- Minimum of 4 hours of class/academic work per week
- Minimum of 50 hours total attendance
- Active participation in class
- Complete required placement and process testing
- Attend all scheduled appointments and classes
- Active communication with instructors/staff
* Failure to meet these expectations will result in separation from the program.

Services We Do Not Provide:
- We do not provide services if not lawfully present in the United States
- We do not meet the requirements for obtaining a student visa
- We do not administer the citizenship exam
If you have additional questions, please contact the Adult Education Program Assistant:

Linda Fullerton
928-526-7639
Linda.Fullerton@coconino.edu
Workforce Training/Employment Program Information:
Services Provided:
- Select Workforce Certification Programs at no cost
- Various paid Workforce Certification Programs (Financial assistance available through county partners)
- Classes offered online with in-person support service
- Individual success coaching
- Tutoring services
- Access to college and community resources
Expectations:
- Minimum of 4 hours of class/workforce training per week
- Minimum of 12 hours of attendance in academic courses
- Continued attendance in academic services
- Complete placement and progress testing
- Attend all scheduled appointments and classes
- Active communication with instructors/staff
* Failure to meet these expectations will result in separation from the program

If you have additional questions, please contact the Adult Education Program Assistant:

Linda Fullerton
928-526-7639
Linda.Fullerton@coconino.edu
Should be Empty:

Adult Education Registration Screening Form

GED/High School Equivalency Program Information:

English as Second Language Program Information:

Workforce Training/Employment Program Information: