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, 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:

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!