WorkReady U Intake Form

Adult Education Program - Louisiana Community & Technical College System

Student Contact Information

Student Name

Emergency Contact Information

Emergency Contact Name

Demographic Details

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Race (select one or more)

Education Details

Accessibility Details

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Workforce Details

Do any of the following statements apply to you? (Check all that apply)

Goal Details

What other goals would you like to pursue? (optional, choose all that apply)
Do any of the following goals apply to you?

Learning Preferences

What types of classes are you interested in? (check all that apply)
What times are best for you to attend classes? (check all that apply)

Other Details

How did you hear about us?
In the Americans with Disabilities Act of 1990, a disability is defined as a physical or mental impairment that substantially limits one or more of a person's major life activities.
Accommodations Agreement
If you have a disability and/or a condition for which you would like special accommodations for instruction or testing, it is your responsibility to notify the program's administrative office and provide professional documentation.
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