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JPCC's Adult Learning Program 

ALP Student Enrollment Form

Today's Date
Jour
Mois
Année
Date of Birth
Jour
Mois
Année
Make a Selection:
New Student
Returning Student
HiSET - English
Hernandez K-8 Student
Margarita Muniz Academy
JPNDC
CNA (Certified Nursing Assistant)
Schedule Choice:
Morning
Evening
Which of the following do you have at home so we can contact you and/or connect you to services? (Check all that apply):
Sex
Male
Femail
Other/Prefer Not to Disclose
Pronouns:
Start Date
Jour
Mois
Année
Service (Check the one that best applies):
Secondary Service
WIOA Core Program (Check One)
Are you Hispanic/Latino
Yes
No
What is your Race (Check all that apply)
First Language (L1)
L1 Reading/Writng Proficiency
Second Language (L2)
L2 Reading/Writing Proficiency
Primary Language
First Language
Second Language
Highest educational level completed on entry (Check one)
No schooling
Grade 1 - 5
Grade 6 - 8
Grade 9 - 12
Secondary School Diploma or Alternate Credential
Secondary School Equivalent
Some Postsecondary Education, No Degree
Postsecondary or Professional Degree
Where did you receive your highest level of education?
U.S. Based Schooling
Non-U.S. Based Schooling
Were you ever enrolled in a Massachusetts public school (K12, Adult Education, Community College)?
Yes
No
Employment Status at Program Entry (Check the one that best applies)
Employed
Employed - Multiple Jobs
Employe with Separation Notice
Unemployed - not employed but seeking employment, making a specific effort to find a job, and is available to work
Retired
Unavailable to work
Not looking for work

Employed definition:

(a) is currently performing any work as a paid employee

(b) is currently performing any work at his/her own business, profession, or farm

(c) is currently performing any work as an unpaid worker in an enterprise operated by a member of the family

(d) is not working, but currently has a job or business from which he/she is temporarily absent because of illness, bad weather,

Barriers to Employment (Check all that apply. Must select at least either "English language Learner" or "Low Literacy Levels")

Migrant Farmworkers – a person who meets either of the following:

  • A low-income individual who for the 12 consecutive months out of the 24 months prior to program entry has been primarily employed in agriculture or fish farming labor that is characterized by chronic unemployment or underemployment and faces multiple barriers to economic self-sufficiency.

  • A dependent of the individual described as a seasonal or migrant seasonal farmworker above.


Apparent or Disclosed Disability
Yes
No
Specific Learning Disability
No
Yes - Disclosed
Yes - Documented
Public Assistance (Choose one or more if "yes")
I agree to allow the Adult Learning Program to keep this information confidential and not to use this information for any purpose other than the purpose of adult education.
Yes
No

INFORMATION

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JPCC/ALP

20 South Street

Jamaica Plain, Massachusetts 02130

Information Number: (857) 728-0400

Email: info@jpadulted.org

MBTA Directions

 

Take the Orange Line to Green Street Station. 20 South Street is a 10 minute walk from the Orange Line at the Green Street stop.

 

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IN PARNERSHIP WITH:
Funding Provided by:
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