Adult Education Online Form

Contact Information

First

Middle

Last

Phone Number

Alternate Phone Number

Street Address

Street Address (Line 2)

City

Zip Code

County

What types of classes are interested in taking with us?

College and Career Readiness (HiSET or GED Prep)
Reading, writing, and math skill building classes to help with college and career readiness goals as well as passing the HiSET or GED.

English Language Learning
English classes to help non-native speakers improve speaking, listening, reading, and writing skills.

Accelerated Career Education Program
Integrated education and training classes where students can earn industry credentials and college credit in career pathways: information technology, healthcare, construction trades, and culinary/hospitality.

Smart Start Classes
Classes designed to help students earn a Career Readiness Creditial (CRC), explore career options, and learn necessary skills for employment.

Online Classes with Adult Education
Online courses to help with college and career readiness goals as well as passing the HiSET or GED.

Emergency Contact Information

Emergency Contact Full Name

Their Phone Number

Their Relationship to You

Personal Information

Check this box if you are a US citizen

Date of Birth

Day

Year

Gender

Marital Status

Education Details

Highest level completed

School location

Employment Details

What is your current employment status?

Employer

Occupation

Migrant and Seasonal Farmworker Status

Long-term Unemployed (More than 27 consecutive weeks)

Select this box if you have been unemployed for more than 27 consecutive weeks

Race/Ethnicity/Language Information

Race

Country of Origin - if not US

Native Language - if not English

Additional Details - This information is optional, however, sharing it with us can help us to better understand the needs of our student body and provide additional programming and services for all of our students.

Are you a single parent?

Do you live in a rural area?

Are you a displaced homemaker?

Are you a dislocated worker?

Are you in state-paid foster care?

Are there cultural barriers hindering your employment?

Are you currently in foster care?

Have you aged out of foster care?

Are you receiving TANF assistance that ends within 2 years?

Please check this box if you receive assistance through any of the following programs.

SNAP, TANF Assistance, SSI Assistance, State or local income-based public assistance

Electronic Signature - I, the [applicant, requestor, etc.] for this Application, warrant the truthfulness of the information provided in this application. Please type your First and Last Name.

I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.

Adult Education Online Form

Register for Online Classes

Contact Information

Emergency Contact Information

Personal Information

Education Details

Employment Details

Race/Ethnicity/Language Information

POPLARVILLE CAMPUS
101 HIGHWAY 11 NORTH
POPLARVILLE, MS 39470

FORREST COUNTY CAMPUS
5448 HIGHWAY 49 SOUTH
HATTIESBURG, MS 39401

HANCOCK CAMPUS
454 HIGHWAY 90, Suite D
WAVELAND, MS 39576

Each community college president is asked to bring two (2) wrapped door prizes, minimum value of $50 each. We will have a station set up at the conference for you to drop off the door prizes.

Each community college is asked to provide name tags for their Board members, administration, and staff attending the conference.

Get
Info

Schedule
A Tour

Apply
Now

Adult Education Online Form

Register for Online Classes

Contact Information

Emergency Contact Information

Personal Information

Education Details

Employment Details

Race/Ethnicity/Language Information

POPLARVILLE CAMPUS101 HIGHWAY 11 NORTHPOPLARVILLE, MS 39470

FORREST COUNTY CAMPUS5448 HIGHWAY 49 SOUTHHATTIESBURG, MS 39401

HANCOCK CAMPUS454 HIGHWAY 90, Suite DWAVELAND, MS 39576

Each community college president is asked to bring two (2) wrapped door prizes, minimum value of $50 each. We will have a station set up at the conference for you to drop off the door prizes.

Each community college is asked to provide name tags for their Board members, administration, and staff attending the conference.

GetInfo

ScheduleA Tour

ApplyNow

POPLARVILLE CAMPUS
101 HIGHWAY 11 NORTH
POPLARVILLE, MS 39470

FORREST COUNTY CAMPUS
5448 HIGHWAY 49 SOUTH
HATTIESBURG, MS 39401

HANCOCK CAMPUS
454 HIGHWAY 90, Suite D
WAVELAND, MS 39576

Get
Info

Schedule
A Tour

Apply
Now