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Beaumont Adult Education
Community Interest   Computers   Healing Arts   Instructions	Fields with a "*" are required.   Student First Name  * Student Last Name  * Address  * City  * State  * ZIP  *   Home Phone  * Work Phone  Cell    Email  * Confirm Email  *   Sex  Male  Female Ethnicity  Hispanic or Latino Not Hispanic or Latino Race (mark all that apply) White Asian Black or African American  Native Hawaiian or other Pacific Islander  Filipino American Indian Alaska Native Number of years of school completed  0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Degree Earned  None GED Certificate High School Diploma  Technical/Certificate  AA/AS 4 yr. College Graduate Graduate Studies Other Native Language  English Spanish Vietnamese  Chinese  Hmong  Cambodian  Tagalog Korean  Lao Russian  Farsi Other  Reason For Enrollment    Primary     Secondary     Improve basic Skills Improve English skills HS Diploma/GED Get a job Retain job Enter college or training Work-based project Family goal US Citizenship Military Personal goal None Other Personal Status (mark all that apply) TANF Other Public Assistance WIA 1B  Rehabilitation  Concurrently enrolled in high school/K-12  Dislocated Worker Veteran Disabled  Displaced Homemaker Single Parent  Bogg Grant Pell Grant  GA (Gen Assist.) SSI  Bur. Indian Aff.  Other  Labor Force Status  Employed Unemployed Not employed and not seeking work   Retired  Annual Income Single person and income below $7,500 per year (add $1,000 for each dependant child) Married and combined income is below $15,000 per year (add $1,000 for each dependant child) None of the above Create your own User ID and Password.  Note them for future use. (User ID & Password are case sensitive.)   User ID  Password  Re-confirm Password