GED Learner Application

Name:*

Street address:*

City, State:*

Zip code:*

Phone number:*

( ) -

Email:*

How did you hear about the GED/HiSET tutoring program?:*

Is English your native language?:*

Yes
No

If no, which language is?:

Do you have a current library card?:

How often do you go to your local library?:

Emergency contact name:*

Emergency contact phone number:*

( ) -

Emergency contact relationship (family/friend)?:

Date of birth:*

Today

Gender identity:*

Ethnic identity and origin:*

If other, you can write in your Hispanic, Latinx or Spanish origin here

Racial identity:*

You may check more than one if they apply to you

If Other, or if you wish to further specify your heritage, you can write your race or origin here

Which library location is best for you to meet with a tutor?:*

Please enter a specific branch name

Are you interested in virtual tutoring?:*

Yes
No

What are the best days and times for you to meet with a tutor?:*

Examples: Mondays 1-5, anytime on Saturdays, etc.

Tutor preference:*

Female
Male
No preference

GED-HiSET Learner Application