EmailMeForm
2025-2026 HSE Class Registration Form.
Complete the form below to be added to our waitlist for the next available orientation for the class location selected. We will contact you with more information on dates and times of the orientation and confirmation.
Select a class location:
*
Eldon Eve - Monday & Wednesday - 4PM to 8:30PM
Fulton Day - Tuesday & Thursday - 9AM to 12PM
Jefferson City Day - Monday/Wednesday - 9AM to 1PM
Jefferson City Eve - Monday/Wednesday; Tuesday/Thursday - 6PM to 9PM
Versailles Eve - Tuesday & Thursday - 4PM to 8PM
AEL - Virtural - Online
Name:
*
First
Last
Social Security Number
*
XXX-XX-XXXX
Birthday:
*
MM
/
DD
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YYYY
AGE:
*
Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
Phone:
*
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Email:
*
Preferred Method of Contact:
*
Phone call
Email
Best time to call:
Morning
Afternoon
Evening
Program Type:
Adult Basic/Secondary Education
English Language Learner
Secondary Program: (select all that apply)
IELCE
Community Correctional
Correctional Facility
Other Institutional Setting
Workplace AEL Activities
Not Applicable
Gender:
*
Female
Male
Hispanic?
*
Yes
No
Race:
*
American Indian or Alaskan
Asian
Black or African American
Native Hawaiian/Pacific Islander
White
Highest Level of Education:
*
No Schooling
Grades 1-5
Grades 6-8
Grades 9-12
HS Diploma or Alt. Credential
High School Equivalency Certificate
Some Postsecondary, no diploma
Postsecondary/Professional Degree
Unknown
Labor Force:
*
Employed
Unemployed
Not in the Labor Force
Employed (received notice of termination)
Location of Highest Level of Education:
*
United States Based
Non U.S. Based
Barriers to Employment: (select all that apply)
*
Cultural Barriers
Disabled Individual
Displaced Homemaker
Low Income
English Language Learner
Ex-Offender
Exhausting TANF within 2 years
Youth in Foster Care
Homeless
Long-term Unemployed ( 27 or more weeks)
Low Literacy Levels
Migrant Farmworker
Seasonal Farmworker
Single Parent/Guardian
Referred by:
*
Community Action agency
Missouri Job Center
Employer
Vocational Rehabilitation
Probation and Parole
Family Services Division
Relative/Friend
Other
I certify that the information given on this application is true and accurate to the best of my knowledge and belief. I consent to the release of my records maintained by a state or local education agency, including the information on this form and transcripts, grades, certificates, the High School Equivalency, and diplomas earned by me. This information may be used by the Missouri Department of Elementary and Secondary Education and shared with other state agencies for research and reporting purposes. Data shared between agencies includes, but is not limited to, employment, additional schooling and follow-up services provided to you by agencies identified in the Workforce innovation and Opportunity Act (2014). Currently, as of this date, I am not enrolled in a secondary school institution or receiving homeschool services.
Signature
*
Clear
Date Time
*
MM
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