KYC GED Preparatory Program Application

 Please complete the information below:

1. GED APPLICANT NAME/Contact Information:

 

 Last Name: First Name: Middle initial:

 DOB (MM/DD/YY)

  Contact number: home         cell:

 Email contact:

  I currently reside at: 

 

 I have lived at this address since:

 

Is English your primary language? Yes   No IF NO, what is your primary language? __________

Do you have access to internet at home? Yes     No

Do you have access to a computer (laptop/desktop/iPad) at home? Yes     No

 

2. EDUCATION

Indicated Highest Level Completed:   Elementary ☐     Middle School ☐ Partial H.S. ☐

 List school(s) attended:

 Do you have any special learning needs?  

Indicate which subjects you have received Regents credit for (if applicable):

Mathematics ☐ Science ☐ ELA ☐ History/Social Studies ☐

When did you last attend school or attend a GED preparation program?  Please describe your experience below:

 

 

 

 

 

 

 

 

3. EMPLOYMENT HISTORY – list employment history below (paid or volunteer)

 Current employer

 Employer’s address

 Number of years employed

 Previous employers – list previous employers below and number of years worked at site(s),  OR attach a resume.

 

 

 

 

 

4. GED Schedule

KYC’s GED preparatory program offers classes as follows:

Session	Subject	Monday	Tuesday	Wednesday	Thursday
M-1	Mathematics
S-2	Science
H-1	History
R-2	RLA

Please indicate which sessions you are interested in by placing an “X” in the appropriate box.

 

5. Miscellaneous

 

Please feel free to share information that you feel is relevant to your educational needs that we should know about.