HSE Application

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*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

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

Marital Status:*

  • Married
  • Single
  • Separated
  • Widowed
  • Divorced
  • Single Divorced

Are you a veteran?:*

  • Yes
  • No

Are you disabled?:*

  • Yes
  • No

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:

By clicking below, I consent to receive calls and/or text messages* by a college representative with information for educational opportunities at the number(s) provided above. I understand calls may be initiated by an automated telephone dialing system. I need not grant this consent to receive information or to be eligible to enroll with ACC. I also understand that if I no longer wish to receive text messages from ACC, I can text back "Stop" at any time to unsubscribe from the service. (*Standard rates may apply.)

Consumer Notice

 

Click here for the Student Supplemental 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 (877) 337-5129. Our representatives are happy to talk with you and go through your options. Call today!

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