Join an Adult Education Class

To begin the application process and join a free Adult Education class, please submit the Student Intake form to the Adult Education program.

Adult Education will contact you by email or text messages to discuss your next steps for completing enrollment and registration requirements. If you have not been contacted within one week of your submission, please call 815-224-0358.

Para traducir este formulario al español, vaya a: Google Translate

I am a client of:*

IDES - Illinois Dept. of Employment Services

DHS - Dept. of Human Services or ORS - Office of Rehab Services

BEST - Business Employment Skills Team

N/A - Not Applicable

Which type of Adult Education class are you interested in joining? (CHOOSE ONE CLASS)*

Illinois High School Diploma (GED) classes

English as a Second Language (ESL) classes

Citizenship classes

ICAPS

STUDENT BIO/CONTACT INFORMATION

Social Security Number (SS#)*

I have a SS# and will be prepared to enter it on paperwork at registration..

I do not have a SS#.

LAST name*

FIRST Name*

Middle Name or Initial

Address*

City *

Zip Code*

County*
E.g. (LaSalle, Bureau, etc.)

What is your email address?
Potential GED students need to provide an email.

Cell/Mobile Phone*

Home Phone (Landline - if applicable)

Emergency Contact Person (Name)*

Emergency Contact (Phone #)*

Your Date of Birth*

Your Gender*

Marital Status*

Is English your native language? *

Yes

No

If no, what is your native or primary language?

Are you Hispanic or Latino?*

Yes

No

Are you from one or more of these racial groups? (Select all that apply)*

American Indian/Alaska Native

Asian

Black/African American

Hispanic/Latino

Native Hawaiian/other Pacific Islander

White

Identify your PRIMARY racial/ethnic group. (Choose one)*

EDUCATION

School Type - Did you attend school in the United States?*

Yes - U.S. Based Schooling

No - Non-U.S. Based Schooling

What was the month and year you were last enrolled in a U.S. based or school outside of the U.S.?

How did you hear about our program?*

What was the grade/year of school you last completed? Choose one.*

Do you have a diploma issued by a U.S. high school?*

Yes

No

Do you have a U.S. high school equivalency such as a GED?*

Yes

No

Upon completion of GED testing, do you give consent for IVCC to obtain your test scores?*

Yes

No

Do you give permission for IVCC to use your information to provide you with remote testing options? *

Yes

No

Did you pass the Illinois Constitution Test while in high school?*

Yes

No

Not Sure

STUDENT STATUS/EMPLOYMENT

Disability Disclosure*

Do you live in a:*

Employment - I am currently:*

If employed, how many hours a week?

Do you receive Public Assistance?*

Yes

No

I am currently in a:

Do you have reasons or barriers that would prevent you from attaining your educational goals? If yes, please explain.

Career Pathway Interest (Choose one)*

Preferred Class Location (CHOOSE ONE LOCATION)*

CONSENT FOR RELEASE OF INFORMATION NOTICE:
Upon official enrollment into an active semester at Illinois Valley Community College in the Adult Education program, I do hereby authorize IVCC Adult Education to obtain information from and/or release information to employers, agencies, probation officers, schools, and other IVCC staff regarding my attendance, academic record, or testing results.

I have read and understand the Consent for Release of Infomation agreement..*

Yes, I have read and agree to the Consent for Release of Information.

Please type your full name and today's date to serve as an electronic signature.*