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Omega School Student Enrollment Form

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Last name:
First name:
Middle initial:
What name do you want to go by at Omega School?
Social Security Number:
Date:
City:
State:
ZIP code:
Home Phone:
Cell Phone:
Education completed: (Write in the highest grade completed in the United States)
 

The highest grade I completed was at

School.
  I was educated in a country other than the United States.
Which country?
Hobbies and interests:
Educational Goal: (Choose all that apply)
  Obtain GED diploma
  Obtain the HSED Diploma
  Enter College or Technical School
  Read to my children
  Study for an Apprenticeship or trade
Employment Status: (Check one)
  Employed part-time at:
  Employed full-time at:
  Unemployed (looking for work)
  Not in Labor Force (not looking for work)
  Collecting Disability
Family Status: (Choose all that apply)
 

Parents of children (ages 1-17) Names & ages:
  Single
  Living with Parents
  Living with Friends
  Homeless
Key Contact Person: (Name and address of someone who wants you to complete GED?HSED)
Name:
Home phone:
Address:
Email:
 

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