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 Sutter County Adult Education 
 ABE - Adult Basic Education 
 CPR 
 Citizenship 
 Computer Applications 
 ESL - Beg/Int 
 ESL - Int/Adv 
 GED 
 High School Diploma 
 
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Student First Name  *
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Student Last Name  *
Address  *
City  *
State  *
ZIP  *
 
Home Phone  *
Work Phone 
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Email  *
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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 
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
Special Programs*
None
Jail
Community Corrections
State Corrections		 Homeless Program
Family Literacy
Workplace Ed
Tutoring		 Distance Learning
Special Needs
Alternative Ed (K-12)
Non-traditional Training		 EL Civics
Carl Perkins
Others
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