HSE Application

*Required fields for demographic and enrollment purposes

First Name:*

Last Name:*

Address:*

Zip:*

City:*

State:*

Email:*

Phone:*

Date of Birth:*

Select nearest location to you:*

Gender:*

  • Male
  • Female

US Citizen?:*

  • Yes
  • No

If not citizen, are you a permanent resident?:

  • Yes
  • No

Alien Registration Number:

Ethnic Group:*

  • White
  • Hispanic/Latino(a)
  • Black/African American
  • Asian
  • American Indian or Alaska Native
  • Pacific Islander
  • Two or more races
  • Filipino
  • Race & Ethnicity Unknown

Martial Status:*

  • Married
  • Single
  • Separated
  • Widowed

How many people are in your household*

Household Language:*

Household Income Range:*

  • $0-37,000
  • $37,001-50,000
  • $50,001-65,000
  • $65,001 +

Highest Grade Level Completed*

  • 9
  • 10
  • 11
  • 12

Emergency Contact:

Phone:

Alternate Contact:

Phone:

Brief description of your reason for leaving High School:

How did you hear about us :

Do you have reliable transportation?:

  • Yes
  • No

Do you have reliable day-care?:

  • Yes
  • No
  • Not applicable

Are you currently employed?

  • Yes
  • No

If YES, please provide your work schedule:

 

Click here for the Student Supplimental Registration form

Ready to start now on your brighter future? Call Today!

We are here to help you prepare for your HSE exam and succeed! Many people dream of a brighter and successful future, and we can help you make that dream a reality.

It starts with a phone call at (949) 783-4329. Our representatives are happy to talk with you and go through your options. Call today!