Adult Education and Literacy Application

Personal information

Legal name

First name

Middle name

Last name

Name suffix

Do you have a chosen or preferred name?

Chosen/Preferred name

This is an option for people who wish to use a name other than their legal name to identify themselves. If you use your legal name, you do not need to specify a chosen/preferred name.

ECC recognizes that faculty, staff and students may use names other than their legal name to identify themselves. These may include, but are not limited to, people who use their middle name instead of their first name, people who use nicknames of a legal name, people who use an anglicized name, or people who use a name that affirms their gender identity.

Yes

Chosen/Preferred name

First name

Middle name

Last name

Do you have any previous names? (Ex. Maiden or other legal name changes)

Yes

Previous name(s)

Ex. Maiden or other legal name changes

First name

Middle name

Last name

First name

Middle name

Last name

First name

Middle name

Last name

Add Name Remove Name

Select your citizenship status

U.S. Citizen

Permanent Resident

Not a U.S. Citizen

Do you have an F1 Visa?

Yes

Based on the visa requirements, you are ineligible for Adult Education and Literacy services. You can apply to East Central College using the standard Application for Admission.

Mailing address

City

State

ZIP code

Proof of residency in the East Central College district may be required.

Primary language

Birthdate

Students who have not completed a high school credential are not eligible for financial aid. Students who are pursuing a college degree and diploma program at the same time will need to provide proof of high school credential completion, before a college degree can be conferred.

Any student who wishes to give others, such as parents and/or supporters, access to their academic and financial records must complete a FERPA Privacy Waiver.

Social Security number

Confirm Social Security number

Entering an incorrect social security number will cause delays in processing your application.

Email (Do not use school email address)

Cell phone

Alternate phone

ECC often communicates by text message. Standard text rates will apply.

Are you a Veteran or are you currently serving in the U.S. Armed Forces?

Veteran

Currently Serving

Military Spouse/Dependent

Not Applicable

Gender assigned at birth

Female

Male

Personal pronouns

Are you Hispanic/Latino?

Yes

Race (choose one or more)

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Supporter contact information

Completing your educational goals takes determination and support from those around you. If you would like us to share important college info (such as enrollment deadlines) with someone in your life, please enter and email address AND phone number below. If you want to keep that information to yourself, just click Not Applicable.

First name

Last name

Supporter email

Supporter phone

Not Applicable

Emergency contact information

Emergency Contact 1

First name

Last name

Best contact number

Relationship

Parent

Guardian

Spouse

Other

Please state relationship

Emergency Contact 2

First name

Last name

Best contact number

Relationship

Parent

Guardian

Spouse

Other

Please state relationship

Tuberculosis (TB) screening

All new students intending to seek admission into East Central College must be screened for Tuberculosis (TB).

Please read and answer the following set of questions:

Have you ever been diagnosed with TB?

Yes

Have you ever been in contact with someone who has, or had, TB?

Yes

Were you born outside the United States?

Yes

Which country?

Have you engaged in frequent or prolonged visits outside the United States?

Yes

Have you engaged in military service outside the United States?

Yes

Have you been a volunteer or health care worker who served clients who are at an increased risk for active TB disease?

Yes

ACCESS and Disability services

Access Services provides support for students who have documented disabilities by making reasonable accommodations in regard to academic instruction and other college related activities.

Students enrolling at ECC who are seeking services for a disability must submit appropriate documentation and meet with an Access Counselor to receive services. Click here for the Access Application.

Criminal background

Have you pled guilty to or been convicted of a felony?

Disclaimer: If you have a pending charge, you are required to notify us if you pled or have been found guilty.

Yes

Academic goals

What type of student are you?

Adult Education – high school equivalency (formerly GED), preparation for college, military, or other placement exams

English Language Learner – English as a new language

College Preparation – Computer skills, TEAS and HESI prep, ACT prep

Highest Education Level Completed at Entry

Highest Education Level Completed at Entry Location

Employment Status

Statement of financial responsibility

The Adult Education and Literacy classes you are registering for at this time are provided without cost and are free to the student.

By submitting the application, I am certifying that I am the person who has completed the information on this application and that all the information I have provided is complete and accurate to the best of my knowledge. I am financially responsible for any tuition and fees accrued.

I understand that my name will appear on all college documents as listed above, unless I file a Student Information Form with the Student Service Center. Furthermore, I acknowledge that the college may accept and/or send transcripts to award credit for the purpose of transfer program completion.

I agree that East Central College may use photographic images and video or audio recordings of me, with or without my name and for any lawful purpose, including such purposes as publicity, marketing, illustrations, advertising, web content and/or other purposes without limitation, consistent with the mission of ECC. I voluntarily waive the right to inspect or approve such images and waive my right to any royalties or reimbursement, monetary or otherwise. This release is effective on the date of form submission and will remain in effect indefinitely.